Brazil’s Tropical Forest Protection Fund Launches with $6.6 Billion — Will It Work? 22/11/2025 Stefan Anderson Lula’s flagship scheme has attracted only a quarter of its target funding as Indigenous groups turn from supporters to critics. Brazil’s tropical forest fund aims to be the largest global financial instrument of its kind. But as COP30 enters its final hours, $6.6 billion raised so far falls well short of its $25 billion target. Although that is still considerably more than other climate funding mechanisms, the unique structure of this fund as an interest-generating mechanism makes the target even more important. The Tropical Forest Forever Facility, Brazilian President Luiz Inácio Lula da Silva’s flagship initiative to protect the world’s tropical forests, reached $6.6 billion in pledges as COP30 entered its final hours, with Germany becoming the third nation alongside Brazil and Indonesia to commit $1 billion to the effort. The pledge was a bright moment in a day marked by an impasse over the inclusion of language on fossil fuel transition in the final COP30 agreement – something European Union continued to push for, against stiff opposition from Gulf oil producers and other petrostates, with host country Brazil also reluctant. See related story. Fire Hits COP30 Climate Talks in Crucial Juncture in Debate over Fossil Fuel ‘Transition’ Brazil has championed forest fund since Dubai “It is symbolic that the celebration of its birth is taking place here in Belém, surrounded by sumaúmas, açaí palms, andirobas, and jacarandás,” Lula told the COP. “For the first time in history, countries of the Global South will take a leading role in a forest agenda.” The billions raised mark significant progress for the highly technical financing instrument that Lula has championed since COP28 in Dubai, set up to pay tropical forest nations for keeping trees and their surrounding forests standing rather than cutting them down, rewarding conservation with cash instead of traditional grants. But the president’s soaring language masked a fundamental problem: the fund remains well short of the $25 billion target Brazil set for government investments, designed to secure investor confidence and unlock an additional $100 billion in private financing for a total goal of $125 billion. Current funding flows to the Tropical Forest Forever Fund, according to the initiative’s website. Norway is the largest contributor by far, pledging $3 billion over ten years, nearly half the current total. France committed €500 million, while smaller pledges came from Portugal ($1 million) and the Netherlands ($5 million) to assist with technical matters pertaining to the fund’s secretariat. In effect, the entire tranche of start-up funding raised over the course of COP30 comes from just five nations, two of which, Brazil and Indonesia, are set to be major beneficiaries of the fund itself. Notably absent from the investor line-up were major economies that had previously expressed interest in supporting the fund, including China, Saudi Arabia, and the United Kingdom. The United States, viewed as another possible backer under former president Joe Biden, has reversed course under Donald Trump’s administration. UK withdrawal was a last minute blow Britain’s withdrawal came as a last-minute blow to Lula’s flagship project: the UK had been involved in designing the facility and pioneered tropical forest preservation when it hosted COP26 in Glasgow, but declined to invest on the eve of the summit due to a view in Downing Street that the effort remains in “too early a stage” to commit substantial finance, according to reporting by the Guardian. “It is telling—and concerning—that the UK, as one of the world’s richest countries, has not announced an investment to match those from less wealthy countries,” said Tanya Steele, chief executive of WWF-UK. The need for finance to protect the world’s tropical forests from the Amazon to the Congolian rainforests is urgent, despite repeated global pledges to protect them. The 2025 Forest Declaration Assessment shows that deforestation is continuing at crisis levels, with 8.1 million hectares lost in 2024 alone, 63% above the rate needed to meet 2030 targets. “At the halfway point to 2030, the world should be seeing a steep decline in deforestation. Instead, the global deforestation curve has not begun to bend,” the latest assessment found. “Financial flows are still grossly misaligned with forest goals, with harmful subsidies outweighing green subsidies by over 200 to 1.” At least 92 countries in attendance at COP30 back a separate “roadmap” to combat deforestation pushed by Lula, which Brazil had wanted to be one of the key outcomes of the summit – although it was not mentioned in the latest draft outcome text. The roadmap is supported by the EU and the Coalition for Rainforest Nations representing over 50 rainforest countries, more than the 82 nations supporting the parallel fossil fuel phase-out roadmap, according to Carbon Brief. The majority of remaining forests outside that coalition sit in Russia, Canada and the US, none of which support the roadmap in its current state. Despite the uphill battle, Lula has characterised the fund as a centrepiece of Brazil’s climate agenda. “The Tropical Forest Forever Facility will be one of the main tangible outcomes in the spirit of COP30 implementation,” he said. “In just a few years, we will begin to see the fruits of this fund. We will take pride in remembering that it was in the heart of the Amazon rainforest that we took this step together”. From carbon storage to pathogen regulation – high health stakes of forest loss Tropical forests store 15-20 years’ worth of global carbon emissions and represent roughly 30% of the planet’s carbon storage. Scientists warn that cumulative deforestation could trigger a catastrophic tipping point, converting forests to deserts. The health consequences make the degradation even more urgent as forests such as the Amazon as well as central Africa, Indonesia and elsewhere play a critical role for health in weather regulation, water storage and plant biodiversity. Sixty percent of emerging infectious diseases originate in wildlife, with nearly one-third of outbreaks linked to habitat destruction. In 1997, Indonesian forest fires drove fruit bats carrying Nipah virus into populated areas. 265 people were infected, 105 died. In 2013, a West African boy playing near a tree infested with bats displaced by deforestation became the index case for an Ebola outbreak that killed 11,000. Surveillance in deforested Amazon areas has detected Oropouche fever, a viral disease now spreading across South America, according to research published in The Lancet Infectious Diseases. Climate change compounds these threats. During the record drought of 2024, 11 million hectares burned in Brazil, blanketing cities in smoke and triggering spikes in respiratory and cardiac disease. River levels halved, stranding communities without access to health care, safe water, or food. Illegal gold mining has poisoned rivers with mercury. Each forest lost represents not just carbon released but potential medicines never discovered. Roughly 25% of modern medicines derive from rainforest plants, yet less than 1% of tropical species have been examined for pharmaceutical properties. Indigenous communities have proven to be forests’ most effective guardians, with deforestation rates significantly lower in their territories. Yet for the 30 million people living in the Amazon, including Indigenous nations, riverine communities, and urban residents, environmental degradation carries severe consequences. Unlike traditional climate funds – forest fund is built on endowment model The Tropical Forest Forever Fund’s projected investment model, according to its website. The funding shortfall matters because the TFFF isn’t designed like traditional climate funds. It’s an investment vehicle, functioning similarly to a large endowment, set up to generate “competitive market returns” and a “strong value proposition” for its backers based on a projected return of 7.5% on its assets and investments. Without sufficient capital to generate significant returns, the mathematics collapse. The concept note published by the Brazilian presidency describes it as a mechanism “to support the full range of less-marketable tropical forest ecosystem services,” designed to correct a perceived market failure: it is more profitable to chop forests down for lumber, agriculture or mining the ground beneath them than keep them standing. The facility aims to raise $25 billion from governments as “sponsor capital,” then leverage that to attract $100 billion from private investors who buy bonds. The combined $125 billion will then be invested in a global portfolio of sovereign and corporate bonds, with a particular focus on emerging market and tropical forest country bonds. In the scenario where the fund secures the full $125 billion, countries would receive approximately $4 per hectare annually for standing forest, according to World Bank calculations, provided they maintain deforestation rates below 0.5%, with heavy financial penalties applied for forest loss. Projected financial payouts to tropical forest nations under the TFFF, given full capitalization at $125 billion. The World Resources Institute noted the facility “could be the single biggest source of international finance for Indigenous peoples and local communities,” potentially funding land purchases, fighting illegal mining, and securing rights. But that depends on achieving scale the current funding makes impossible. Despite the steep financing challenges, some groups maintain the fund represents progress. WWF called it “a landmark moment for nature and climate finance.” “The TFFF is already a defining legacy of the Belém COP,” said Mauricio Voivodic, executive director of WWF-Brazil. “Not only for Brazil, but for the entire planet, especially the Global South.” Christopher Egerton-Warburton, a former Goldman Sachs banker whose London firm Lion’s Head Global Partners engineered the structure of the fund, told Global Witness success requires near-perfect execution. “The sun, the moon and stars have to all come together” for the fund to succeed, he said. The math at current funding levels The TFFF payout model, according to its website. With $6.6 billion instead of $125 billion, the fund currently holds 5% of its target. Assuming 7.5% in annual returns, a high rate of profitability that is far from guaranteed, the fund would possess roughly $495 million in annual investment income. After paying private bondholders and government sponsors their shares, approximately $213 million remains for 74 eligible tropical forest countries. That’s less than $3 million per tropical forest nation annually. The 20% earmarked for Indigenous communities amounts to about $43 million total, split among hundreds of territories across three continents. At current levels, the fund projects to pay tropical forest nations roughly 16 cents per hectare, a 96% decrease from the World Bank’s $4 projection at full capitalization. The fund’s model further relies on providing a strong financial incentive for nations currently pushing ahead with deforestation, like Bolivia, to scale back in return for money. If that money isn’t there, the incentive, and projected impact of the initiative on global deforestation rates, is weakened significantly. “Having raised only $5.6 billion from sponsoring and beneficiary countries, it is impossible to imagine that the mechanism can attract $100 billion in investment,” said the Global Forest Coalition following the launch. (Germany’s additional $1 billion commitment arrived after that analysis.) A UNEP report released ahead of COP30 found that annual forest finance alone needs to reach $300 billion by 2030, triple current levels of $84 billion. “All the calculations made by the World Bank regarding the TFFF are collapsing due to the very logic of capital they aspire to conquer: private investors only invest when profits are relatively certain,” GFC said. “Capitalism only bets on the green of dollars, not on the green of forests.” Who gets paid first? TFFF-eligible countries (deep green) and eligible biome areas within these countries (light green), including the tropical and subtropical moist broadleaf forest biome and adjacent mangrove areas. Map: Global Forest Coalition. If investments hit the target 7.5% annual return, the fund generates roughly $9.4 billion. But that money doesn’t go straight to forests, and $120 billion in assets needed to generate that return are still missing. First in line for payment are the bondholders, private investors and major financial institutions who would receive approximately $4 billion in annual returns on a combined $100 billion share in the fund. Second come the developed country government sponsors, which would collect roughly $1 billion in interest on their $25 billion seed investment. Only after investors and sponsors take their cuts does money flow to tropical forest countries. Under ideal conditions, assuming the fund hits both the $125 billion base and achieves 7.5% returns, tropical forest nations would receive approximately $4 billion annually, less than half of what the fund generates, as more than half is used to incentivize investment from wealthy nations and private capital. The facility mandates that at least 20% of payments to forest nations flow directly to Indigenous communities, meaning roughly $800 million, while $3.2 billion goes to national governments. The direct funding to Indigenous peoples and local communities is unique among global climate finance instruments, which typically channel money through national governments. The payment waterfall is explicit: investors first, forest nations and indigenous frontline communities last. The income generated by the assets held in the fund depends on successful returns on investment and global economic conditions. If a global economic downturn occurs, the entire structure could collapse. “As TFFF is an investment fund its returns cannot be guaranteed,” the fund’s framework states. “In the event that the market value drops below certain key thresholds it may be necessary to reduce the rate of payout to tropical forest nations.” Forest countries receive whatever’s left, which could be far less than the promised $4 per hectare, or nothing. Cash on delivery meets debt Over 60 low-income nations worldwide spent more on debt financing than they spend on healthcare, according to research from UK-based advocacy group Debt Justice. Unlike conventional forest finance that distributes grants directly for conservation, the facility operates what’s known as the “cash-on-delivery” model, meaning governments can spend the money received in exchange for forest preservation however they want. The money received from the fund is not required to be spent on forest protection, though governments will have to submit transparency records on how the money received from TFFF is spent. “The TFFF does not determine how tropical forest countries will use the funds awarded to them,” the concept note states. Beyond generating returns for forest conservation, the fund is also meant to channel capital from developed nations to Global South financial markets. Egerton-Warburton told Global Witness that country sponsors are “increasingly focused” on this “secondary benefit,” “over and above its benefit to the tropical forest countries.” The fund’s investment strategy raises additional concerns amid current worries of a global debt crisis, particularly in low- and lower-income nations across Africa, South America and Asia, many home to the world’s tropical forest reserves. By purchasing sovereign bonds from emerging markets and tropical forest countries, the facility is effectively buying these nations’ debt, then using returns from those bond investments to pay the countries for forest protection. Proponents note this does provide capital to Global South nations that might otherwise struggle to access international markets at favorable rates. However, critics warn the circular structure creates risks. Countries receive payments derived partly from interest on loans they themselves are servicing. With many developing nations already struggling under massive debt burdens, this arrangement could prove problematic if economic conditions deteriorate, potentially trapping forest countries in a cycle where debt payments undermine their capacity to protect forests. Greenpeace raised governance concerns in its statement following the launch: “Instead of prioritizing paying sponsors and investors first, the system should ensure equitable and timely payments to tropical forest countries and Indigenous Peoples.” Carolina Pasquali, Greenpeace Brazil’s executive director, warned of the risks inherent in the market-dependent structure: “As the Facility is dependent on the volatility of global markets, the TFFF funding and the allocation of resources by tropical forest countries must be critically scrutinized to ensure forest protection funds are stable and reliable.” Civil society and indigenous communities turn against TFFF Indigenous peoples’ representatives have shown up in force at COP30. The facility’s reception among Indigenous and forest communities has shifted dramatically since last year, tracking closely with new understanding how the financial structure actually works. Early in the design process, major conservation groups expressed enthusiasm. Brazil conducted consultations with Indigenous leaders, incorporating feedback on direct funding provisions. At the G20 Social Summit in 2024, a joint document crafted by over 2,500 civil society representatives from 91 nations endorsed the forest fund.But as the fund’s financial structures became clear, opposition mounted. More than 200 civil society organisations from Brazil, the Amazon, Asia, and Africa signed a statement strongly opposing the facility ahead of its launch last week. “The TFFF is a mechanism for privatizing forest finance,” it declared. “The TFFF mistakenly and deceptively considers deforestation a market failure that will be resolved by putting a price on ecosystem services to attract private investment. The ecological collapse caused by capitalism will not be solved with more capitalism.” Separately, the People’s Summit on the road to COP30, attended by 25,000 participants, issued a declaration categorising TFFF among “false solutions” to the climate crisis. “We oppose any false solution to the climate crisis that perpetuates harmful practices, creates unpredictable risks, and diverts attention from transformative solutions based on climate justice and the well-being of people in all biomes and ecosystems,” the declaration stated. “We warn that the TFFF, as a financial program, does not constitute an adequate response.” Header from the letter issued by over 200 civil society, indigenous and local community groups strongly opposing TFFF. The mechanism was first conceived more than 15 years ago by a World Bank executive. In 2018, the Center for Global Development circulated a proposal, which the Brazilian government adopted and presented at COP28 in Dubai. Civil society groups objected to the fund being hosted at the World Bank, a common point of contention with other similar funds to funnel capital towards developing nations like the Loss & Damage climate fund, which they view as dominated by major shareholders like the United States. “The World Bank will have significant influence over the TFFF. The wealthy countries that sponsor this mechanism will hold a majority on its board. Developing countries and civil society will have no decision-making power in the governance of the TFFF,” the statement continued. “The TFFF’s profitability is not guaranteed, and in the event of a decline in profits, payments will be made first to the fund’s managers and consultants, then to private investors, then to the sponsoring wealthy countries, and finally to the countries with tropical forests,” the civil society and indigenous community coalition said. The Global Forest Coalition questioned why Brazil and Indonesia would invest $1 billion each in an uncertain mechanism rather than “channel it directly to indigenous peoples and local communities to strengthen solutions like agroecology and promote actions to curb the expansion of deforestation, mining, and oil extraction.” Private capital out of the picture, for now UNEP’s State of FInance for Forests 2025 report found 1 in 10 dollars currently invested in forest finance comes from private sources. The fundraising strategy on which the success of TFFF depends also heavily on something that hasn’t happened: private investors committing capital. After two years of advocacy and political maneuvering, private capital remains entirely absent from the picture. The shaky government backing so far, $6.6 billion versus the promised $25 billion that would absorb first losses and shield private investors from risk, eliminates the safety margin private investors were pitched to join the initiative. The firms floated as possible major investors in the fund, including major multinational banks such as JP Morgan and private equity groups, have remained silent in recent months, with no indications of incoming investments since TFFF’s launch in Belém. Questions also surround the fund’s investment advisers. Bracebridge Capital, a Boston firm serving as one of the advisers, specializes in “high risk bets on debt from struggling economies,” according to Global Witness reporting. The firm was dubbed a “vulture fund” in 2016 for aggressively pursuing claims against Argentina after its debt default. More recently, Bracebridge has made investments far removed from conservation finance, including bailing out the Hooters restaurant chain and building cryptocurrency positions. A crowded labyrinth The launch of the Loss & Damage Fund on the opening day of COP28 in Dubai was lauded as a historic victory. Two years later, it has yet to disburse any funds. The TFFF enters a fragmented ecosystem of global development finance, from health to humanitarian aid and climate change, where even celebrated mechanisms continue to fall dramatically short of their funding targets. The Green Climate Fund, launched in 2010 and posited as the primary vehicle for channeling climate finance to developing countries, raised less than $17 billion over 15 years. The Loss & Damage Fund, celebrated as a landmark achievement of COP28 fought for by developing nations on the frontlines of the climate crisis they did little to cause for decades, has mobilized just $431 million against $724 billion annual needs. Two years after creation, it has yet to disburse any money. The Cali Fund for biodiversity, created at COP16 in Colombia with a target of $500 billion, remains empty as well. At COP29 in Baku, developed countries agreed to $300 billion annually by 2035 for climate action in developing nations. Economists estimate total climate finance requirements at $2.4 trillion annually, of which the Baku target covers around 12%. The labyrinth of overlapping funding structures, each with different governance, eligibility criteria, and reporting requirements, creates contestation and confusion about what counts toward international obligations. Whether TFFF contributions count toward the New Collective Quantified Goal remains hotly debated, especially in view of its unique mechanism in which countries that contribute stand to benefit financially from their investments. Greenpeace argued following the launch that “any contributions to the TFFF should not count towards the NCQG, nor should it divert resources already allocated.” For now, the facility enters operation with a fraction of intended resources, no private investors, and deepening skepticism from the communities it claims to serve. Experts Outline How To Strengthen Trusted Health Knowledge Worldwide 21/11/2025 Maayan Hoffman Global health knowledge is expanding faster than ever, but so are confusion and inequity over who can access trustworthy information and use it to improve their lives. In a live recorded discussion at the World Health Summit in Berlin, featured in the latest Global Health Matters podcast, Joy Phumaphi, executive secretary of the Africa Leaders Malaria Alliance, and Monica Bharel, clinical lead for public sector at Google, reflected on how health information has changed and what it will take to make it truly inclusive. Phumaphi recalled a time when there was effectively one global reference point. “Everything was recorded … by hand,” she said, and “you only had one source of information. That was the World Health Organization.” Today, she noted, “there are so many sources of information, and it’s very, very confusing… We have the rogue scientists and the rogue medical practitioners who spread disinformation.” The danger, she added, is that “the sad thing about both misinformation and disinformation is that is always mixed with a little bit of truth… What it does is that it kills people. You know, people who are not vaccinated during COVID died, and we see children who have not had their measles vaccines dying.” Bharel brought the discussion down to the level of people living on the margins, drawing on her experience caring for patients experiencing homelessness in Boston. She argued that “information is also a determinant of health,” but many people lack “the infrastructure they have to get information… the phones, the internet access, the computer access.” Both speakers stressed the need to strengthen trusted channels. Phumaphi pointed to traditional, religious and social leaders as key messengers, saying health actors “should impart the right information to these… leaders, and even perhaps to the influencers.” Digitalization and AI, they concluded, can be part of the solution. Phumaphi called them “a huge opportunity,” saying, “we can reduce poverty, we can reduce ill health… We can bring the disenfranchised into the fold so, but we have to harness this in the right way and make it available to everybody.” Bharel echoed the urgency: “We can close the gap in health equity and bring in those disenfranchised individuals… we can get people the right information at the right time, at the right level, that they can digest it, and we can do this now.” Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters Podcast. Global Fund Raises $11.4 Billion, Including $4.6 Billion From United States 21/11/2025 Kerry Cullinan The opening of the Global Fund’s Eighth Replenishment Summit, co-hosted by South Africa and the United Kingdom, a high-level, hybrid side event convened on the margins of the G20 Leaders’ Summit. Johannesburg, South Africa, on Friday 21 November, 2025. JOHANNESBURG – The United States pledged $4.6 billion to the Global Fund during its eighth Replenishment Summit in Johannesburg on Friday – a reduction from its previous pledge of $6 billion, but also an indication that it has not abandoned all multilateral global health efforts. The Global Fund has now raised $11,4 billion of its $18 billion target for the next three years – but several key countries and groups, including France, Japan and the European Commission, have yet to pledge. South African President Cyril Ramaphosa, who co-hosted the Replenishment, said that it was a milestone at a time when multilateralism is being “sorely tested”. “Building resilient health systems, scaling up local manufacturing of medicines, diagnostics and therapeutics and securing sustainable financing are vital for the social and economic development of the people of the world who are vulnerable,” said Ramaphosa. “Without a healthy population, nations cannot prosper. It is therefore essential that we close gaps in access to medicines, diagnostics and therapeutics and financing so that every country can protect its people and achieve health equity.” South African President and Replenishment co-host Cyril Ramaphosa United Kingdom Prime Minister Keir Starmer, the other co-host, said this was the first Replenishment to be hosted by countries in the Global North and South. “Since the UK hosted the first Replenishment back in 2002, our shared investments have saved over 70 million lives across more than 100 countries, cutting the combined death rate of these diseases by almost two-thirds,” said Starmer. “Heartbreaking, malaria still kills a child under five years of age every minute, 4,000 adolescent girls and young women still contract HIV every week. TB remains the world’s single deadliest infectious disease, even though we’ve had a cure for almost a century, and the rise of antimicrobial resistance threatens some of the progress that we thought we’d managed,” he added. Starmer praised the growing investment of the private sector in the Global Fund, and the reforms in the development sector enabling countries to drive their own programmes more successfully. UK Prime Minister and Replenishment co-host Keir Starmer Announcing the US pledge via video, Jeremy Lewin, US Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, described the Global Fund as a “critical partner” in advancing his country’s new ‘American First’ strategy. The US had undergone a “rigorous review” of its multilateral commitments, and “left numerous multilateral organisations, including the WHO and Unesco, as they do not work for the American people,” Lewin noted. However, while the Trump administration views “foreign assistance as a tool of US diplomacy” and every taxpayer’s dollar is being assessed in terms of “America First”, the US is “proud of its legacy as the most generous nation in the world”, he added. “The best days of American healthcare leadership are yet ahead. The State Department recently unveiled our new ‘American First’ global health policy, which affirms our commitment to global health but enacts much-needed reforms. “The Global Fund is a critical partner in advancing our America First strategy. It has long advanced the key tenets of our approach, investing much of its resources in scaled procurement of health commodities,” said Lewin. “Under the leadership of [executive director] Peter Sands, we have every confidence that its legacy of excellence will continue,” he concluded. The US pledge is tied to a 1:2 commitment, meaning that every $1 from the US has to be matched by at least $2 from other donors. Last month, Germany announced a €1 billion pledge at the World Health Summit in Berlin (down from €1.4 billion previously). Other substantial donors include Canada, which committed CAD$1.02 billion, the Netherlands, committing €195.2 million; Norway, which committed $200 million; Italy giving €150 million; Ireland increasing its commitment to €72 million, and the Gates Foundation, which pledged $912 million. Image Credits: Global Fund. South Africa May Be Excluded From Future US Grants for HIV Amid Political Row 21/11/2025 Kerry Cullinan South Africa may be excluded from future PEPFAR grants as its relations with the US deteriorate. The United States (US) government has not sought a meeting with South Africa to discuss the resumption of its HIV grant, and it won’t supply the country with the long-acting HIV prevention medication, lenacapavir, amid a deepening political row between the two countries. While US Ambassadors throughout the continent have initiated meetings with African Health Ministers to discuss Memorandums of Understanding (MOU) to set out new terms for the continuation of their US President’s Emergency Plan for AIDS Relief (PEPFAR) grants from April 2026, South Africa has not received such an invitation. “The Department of Health has not received any correspondence from the US government regarding PEPFAR discussions,” Foster Mohale, South Africa’s Health Ministry spokesperson, told Health Policy Watch. A US State Department spokesperson told Health Policy Watch that the US government “is still deliberating future health assistance to South Africa pending broader bilateral discussions”. “The State Department approved the PEPFAR Bridge Plan for South Africa for a six-month implementation period, spanning from 1 October 2025, to 31 March, 2026. The $115 million allocated under this plan supports core life-saving HIV services,” according to the US State Department spokesperson. “The Bridge Plan prioritises service continuity with minimal programmatic changes, focusing on country-specific needs and maximising life-saving impact.” In relation to whether the US would provide lenacapavir to South Africa, a US Embassy spokesperson provided a comment by Jeremy Lewin, Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, stating that the US “will not be contributing doses to South Africa”. “Obviously, we encourage every country, especially countries like South Africa, that have significant means of their own to fund doses for their own population of this innovative American-made drug that Gilead has developed. US-funded doses will not be going to South Africa,” Lewin told a media briefing on 17 November, the day the first 1,000 lenacapavir doses were delivered in Eswatini and Zambia. The US will provide lenacapavir to Eswatini, Kenya, Lesotho, Malawi, Mozambique, Philippines, Uganda, Ukraine, Zambia, and Zimbabwe. Largest HIV+ population A patient getting an HIV test at Witkoppen Clinic, which received PEPFAR for HIV-related services. Around eight million South Africans are living with HIV, around 13% of the population – the largest HIV positive community in the world. In 2024, South Africa received $453 million in PEPFAR funding, and $439 million had been allocated for 2025. But this was suspended when Donald Trump became president on 20 January. In October, the US government approved a $115 million “PEPFAR Bridge Plan” for South Africa for six months from 1 October to 31 March 2026. Relations between the US and South Africa have been rocky since Trump took office, signing an executive order in February to “halt foreign aid or assistance delivered or provided to South Africa”. The order incorrectly claims that South Africa is persecuting white Afrikaners, and has “taken aggressive positions towards the United States and its allies, including accusing Israel, not Hamas, of genocide in the International Court of Justice”. The US has offered white Afrikaners refuge in the US, and Trump has made several disparaging remarks about the country, including at a meeting at the White House with South African President Cyril Ramaphosa. Earlier this month, the US pulled out of the G20 meeting being hosted in South Africa this weekend, with Trump repeating incorrect claims of discrimination against whites as the reason. All 2026 lenacapvir stock bought Lenacapavir, packaged as Sunlenca in the US, where is sells for $42,250 for two injections. The US government and the Global Fund have bought all of Gilead’s 2026 stock of lenacapavir, a twice-a-year injectable that is almost 100% successful in preventing HIV transmission. The Global Fund’s HIV head, Izukanji Sikazwe, told Health Policy Watch that her organisation will supply South Africa and all countries in need with lenacapavir “based on evidence of need”. But eight patient advocacy groups described the rollout of 500 lenacapavir doses each for Eswatini and Zambia as a “public relations stunt” in a media release on Thursday. “Africa and the Global South are being offered merely symbolic handouts, while Gilead and donors shape markets to serve corporate and geopolitical interests, not urgent public health needs,” said Fatima Hassan, director of the Health Justice Initiative (HJI). “By procuring a minuscule number of doses, Gilead can claim that [lenacapavir] is ‘introduced’ in Africa, creating demand and laying the path for commercial bullying instead of introducing the product at actual cost and at scale. This is a profit-seeking, corporate strategy dressed up as solidarity,” she added. Gilead announced in October 2024 that it has authorised six generic manufacturers to sell lenacapavir in 120 low- and middle-income countries, although none are from sub-Saharan Africa. It also excluded several Latin American countries including Brazil and Colombia. The medicine is licensed in the US as Sunlenca for people with drug-resistant HIV, and currently costs $42,250 a year for two injections. The generics are only likely to be available in 2027 at the earliest, and the advocacy groups claim Gilead is “frustrating the speed at which generic entries are possible”, as it has not yet filed an application with India’s drug regulatory authority and has prioritised registration in only 22 countries. ‘Insulting’ The advocacy groups estimate that at least 10 million Africans need lenacapavir to achieve the global goal of a 90% reduction in new HIV infections by 2030, with two million of these being South Africans. However, the US will only provide doses for 325,000 people in 2026 – an “insulting” amount in comparison to the need, said Bellinda Thibela, Health GAP’s International Policy and Advocacy coordinator. “Instead of crumbs, the US should be providing millions of lenacapavir doses, to alter the course of the HIV pandemic and to repair the harms caused by their illegal and deadly cuts to HIV programmes since January,” added Thibela. However, Brad Smith, US Senior Advisor for the Bureau of Global Health Security and Diplomacy, told a media briefing this week that Gilead’s available volume in 2026 is 600,000 doses, but that the US and the Global Fund are committed to buying two million doses. “We anticipate a continued increase in demand and production capability over time to enable us to meet the two million doses sometime in mid-2027,” said Smith, adding that the doses were being split 50/50 between the US and the Global Fund. “We are working out between ourselves exactly who will distribute and procure for which country,” Smith added. Speaking at the same media briefing, Gilead CEO Daniel O’Day said his company was able to “provide Lenacapavir at no profit to Gilead to the countries with the highest burden of HIV”. US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Political decisions Citing the US Executive Order against South Africa, the advocacy groups say that the US has made the country “the target of harsh foreign policy decisions based on the Trump administration’s racism, lies, and conspiracy theories”. Nigeria is also being “pushed out” of lenacapavir support “after being criticised by US government officials, including for refusing to imprison US detainees extracted during US immigration raids”, they claim. “In contrast, Eswatini has accepted the offer of not just the 500 lenacapavir doses ahead of World AIDS Day, but also $5.1 million in funding from the US government in exchange for imprisoning US detainees,” they note. Sibongile Tshabalala, Chairperson of the Treatment Action Campaign (TAC), called for either Gilead to license South African generic companies to make lenacapavir, or for the South African government to “use its lawful powers to issue compulsory licenses”. “Now that the Trump administration has openly tied the global rollout of lenacapavir to a political standoff rewarding ‘compliance’ but punishing African political autonomy and sovereignty, South Africa must step forward with principled global leadership,” the groups add. This story has been updated to include the US State Department’s comment. Image Credits: The Global Fund/ Saiba Sehmi, International AIDS Society, Witkoppen Clinic, Gilead. Global Fund Seeks $14 Billion at Replenishment Summit – With Progress Against HIV, TB and Malaria at Risk 20/11/2025 Kerry Cullinan Deborah and her 10-month-old daughter Catherine at the Baylor College of Medicine Children’s Foundation in Lilongwe, Malawi. Deborah is living with HIV and Catherine is on preventive treatment. JOHANNESBURG – The Global Fund (GF) has only raised $4 billion of its $18 billion budget for the next three years – so much is riding on its Replenishment Summit in Johannesburg on Friday (21 November) as it seeks the balance to advance progress against HIV, tuberculosis (TB) and malaria. The United States has been the largest donor to the Global Fund, contributing around one-third of its budget – but whether it will still contribute generously is an open question, given the Trump administration’s “America First” focus. “We have been in almost constant dialogue with the US since the beginning of the year, and we have not received any stop-work order or any sort of notification that the funding will be stopped,” Francoise Vanni, the Fund’s external relations and communications director, told a media briefing in Johannesburg on Thursday. “We are confident that they will pledge to the Replenishment tomorrow,” added Vanni, pointing out that the US and the GF are working closely to roll out the long-acting HIV prevention medicine, lenacapavir, in several African countries. South Africa and the United Kingdom (UK) are co-hosting the Replenishment, but that did not prevent the UK from cutting its contribution by 15%. The Fund provides 73% of all international financing for TB, 60% for malaria and 24% for HIV. Médecins Sans Frontières (MSF) has described initial pledges as “deeply concerning”. “Germany and the United Kingdom – the only major traditional donors to pledge so far – have both decreased their commitments compared to the last cycle. Specifically, Germany has pledged €1 billion instead of €1.3 billion and the UK has pledged £850 million instead of £1 billion,” MSF noted on Thursday. “No donor has increased their pledge when considering inflation. If other major donors follow Germany and the UK’s examples, the results would be catastrophic for people impacted by TB, HIV, and malaria worldwide,” MSF said. “Failure to meet this [$14 billion] goal would risk catastrophic cuts to essential services, threaten the resurgence of HIV, TB, and malaria – the world’s top three deadliest infectious diseases – and put the financial burden of health care onto the world’s most vulnerable patients.” Members of a spray team prepare their equipment before spraying homes with insecticide to protect families from malaria in Kaukira, Honduras. Saving 70 million lives The GF is the world’s largest funder of global health, and it has saved an estimated 70 million lives since its establishment 22 years ago, according to its Results Report 2025. Around $103 billion has also been saved in reduced hospitalisations, freeing countries’ health systems to address other diseases and other health needs, Vanni noted. While it works in over 100 countries, its effect has been felt primarily in Africa, where 73% of its budget has been spent. In 15 priority countries in sub-Saharan Africa, life expectancy has increased from 49 years old in 2001 to 61 in 2021 – mostly thanks to people with HIV getting access to antiretroviral medicine. In Zambia, for example, life expectancy has increased by 19 years from 43 to 58 years. Since the GF was launched in 2002, AIDS-related deaths have been reduced by almost three-quarters in the countries where the Global Fund operates, and new infections have been reduced by 62%. Without these interventions, AIDS deaths would have increased by 90% and new HIV infections by 75% over the same period. In 2024 alone, Fund-supported TB programmes treated 7.4 million people with TB. Between 2002 and 2023, GF efforts have reduced TB deaths by 40%. Without these, TB deaths would have increased by 134% and TB cases by 40% over the same period. Malaria deaths were reduced by 29% between 2002 and 2023, “even though the population in these countries has increased by 46%”, the Results Report notes. “Without malaria control measures, deaths would have increased by 94% over the same period.” Malaria ‘way off target’ Despite progress, HIV, TB and malaria remain the world’s deadliest infectious diseases. The $18 billion budget could save 23 million lives between 2027 and 2029, avert 400 million new infections and result in a 1:19 return on investment across the three diseases, according to Fund modelling. “Malaria is way off track, with 600,000 people a year dying,” admits Kate Kolaczinski, the Fund’s senior specialist on the disease. “Malaria is the leading cause of outpatient visits in sub-Saharan Africa,” she adds, with 263 million malaria cases in 2023. Between 2002 and 2023, malaria cases in countries supported by the Global Fund increased by 8% “Rising conflict, disruptions from extreme weather events and increasing resistance to antimalarial drugs and insecticides have complicated efforts to combat malaria in 2024,” according to the Results Report 2025. “The goal of ending [malaria] by 2030 looks daunting. Reductions in global health funding could undermine progress against malaria. A widening funding gap, combined with existing crises and an expected population growth in areas at high-risk of malaria, could threaten the lives of millions.” President Duma Boko of Botswana has urged countries to support the Replenishment, noting in an exclusive article for Health Policy Watch: “If the world retreats now, an additional 750,000 children in Africa could die by 2030, and our economies could lose $83 billion in GDP if funding is so low that all prevention interventions are halted.” HIV resurgence? “There’s a risk of HIV resurgence, especially now that we have funding challenges that we’re facing,” says the Fund’s HIV head, Izukanji Sikazwe, pointing out that 9.2 million people living with HIV still need access to treatment. “We are off target for HIV prevention. In 2024, there were 1.3 million new infections. We need a fourfold reduction to meet the 2025 target of 370,000.” Meanwhile, TB surged during the COVID-19 pandemic and but 2024 brought new progress against the disease. “Robust funding commitments in 2025 are absolutely critical to maintaining our momentum against TB and preventing a resurgence that could undo decades of hard-won progress,” according to the Results Report 2025. It describes an “exciting pipeline of innovative tools”, including new TB tests, better treatments and “at least five TB vaccines in phase III efficacy trials”. Private sector contributions While the bulk of the Fund’s budget comes from country contributions, the private sector also contributes – with the Gates Foundation being the biggest and most consistent private donor, contributing $3.91 billion since 2002. “The Global Fund will go down in history as one of humanity’s biggest achievements. It’s also one of the kindest things people have ever done for each other,” according to Gates Foundation chair Bill Gates. The Global Fund’s track record proves it is an excellent investment for our global health dollars. Its work is critical to achieving the goal of ending AIDS, TB and malaria, and making our world a more equitable place for people everywhere.” The Children’s Investment Fund Foundation (CIFF) has significantly increased its contribution recently, focusing on expanding access to lenacapavir by both supporting procurement and the development of generics. John Fairhurst, who heads the Fund’s private sector mobilisation, says that the sector has contributed over $5.3 billion in the past 20 years – often playing a “catalytic role” in innovation. Unlike countries, which give unrestricted funds, private donors can earmark their contributions. Image Credits: Tommy Trenchard/ Global Fund, Global Fund. World Falls Far Short of Methane Cut Targets Halfway to 2030 Deadline 18/11/2025 Stefan Anderson Infrared camera reveals escaped methane emissions from oil rig. Methane leaks from oil and gas make a major contribution to global warming. First UN assessment since the 2021 Glasgow pledge shows methane cuts falling far short of targets needed to meet climate goals. Accelerated action could yield $330 billion in annual benefits by 2030 through improved health and reduced crop losses. Four years after more than 100 countries pledged to slash methane emissions 30% by the end of the decade, a UN assessment has found nations are on track to deliver barely a quarter of that target. The Global Methane Status Report, released Monday at COP30 in the Brazilian Amazon city of Belém, found that current national commitments would cut global methane emissions by just 8% below 2020 levels by 2030. Despite the lack of progress, the 30% target remains technically achievable with increased investment and policy-driven reform, the report found, adding it could yield some $330 billion in benefits to health and cost production, nearly double the cost of investment in methane emissions mitigation. While methane emissions are not a part of formal negotiations in the UN Framework Convention on Climate Change (UNFCC)C, it is the world’s second largest contributor to global warming, after CO2, with a global warming potential 86 times greater. A precursor to ground-level ozone formation, methane is a contributor to air pollution-related deaths as well as reduced crop yields. With an atmospheric lifespan of only about 12 years, reducing methane emissions can yield enormous co-benefits for health as well as reducing the pace of climate change. Collective, non-binding target The Global Methane Status Report produced by the UN Environment Programme is the first comprehensive stocktake of global progress on methane emissions since reduction targets were announced at COP26. The assessment comes as global methane concentrations have reached the highest levels in at least 800,000 years, more than 2.6 times pre-industrial levels, with the gas responsible for roughly one-third of present-day global warming. The new report compiled by the UN Environment Programme is the first comprehensive stocktake since the Global Methane Pledge was launched at the UN climate summit in Glasgow, COP26. The Global Methane Pledge, a non-binding political commitment signed by 159 countries, set a collective global reduction target rather than assigning specific cuts to individual countries or sectors, leaving nations to develop their own strategies and action plans. “Slow climate action means that the multi-decade average of global temperatures will exceed 1.5°C within the next decade,” Ruth do Cutto, deputy climate change chief at UNEP said at a press briefing launching the report. “We must make sure that this overshoot is as short and as low in temperature as possible, and we cannot do that without curbing emissions of methane, which is responsible for one-third of today’s global warming.” Methane’s potency as a greenhouse gas, combined with its relatively short atmospheric lifespan, makes cutting emissions one of the fastest ways to slow near-term temperature rise, often called an environmental “hand brake” by climate experts. “Lack of time is our biggest challenge,” said COP30 President Ana Toni, noting that slashing methane emissions “delivers the fastest results” for slowing warming. Full deployment of what the report calls “maximum technically feasible reductions” could still cut emissions 32% below 2020 levels by 2030, even surpassing the pledge target. These measures would cost an estimated $127 billion annually but deliver benefits valued at $330 billion per year by 2030, including preventing more than 180,000 premature deaths, avoiding 19 million tonnes of crop losses, and reducing global temperatures by 0.2°C by mid-century. “We’re on a highway to hell with the foot on the gas pedal,” Martina Otto, head of the Climate and Clean Air Coalition Secretariat, which produced the report with the UN Environment Programme, said at the launch event in Belém. “If we are heading towards the wall, you don’t just pull the handbrake a little bit. You pull it forcefully and fast. And I think that’s where we are right now,” Otto said. Slow momentum, US wildcard The 159 countries now signed to the pledge, up from just over 100 at launch, represent nearly half of global methane emissions. However, three of the world’s top five emitters remain outside the agreement: China, the largest overall source, India and Russia. China’s participation in a methane summit co-hosted with Brazil and the United Kingdom on the sidelines of COP30 marked a notable diplomatic shift, though Beijing has yet to sign the global methane pledge. Since the pledge’s launch, projected 2030 emissions have improved modestly. Some 127 countries, representing 65% of Paris Agreement parties, now include methane mitigation measures in their latest Nationally Determined Contributions, a 38% increase from pre-2020 levels. New waste management regulations in Europe and North America, combined with slower-than-expected growth in natural gas markets between 2020 and 2024, have lowered forecast emission levels by 14 million tonnes compared with 2021 projections, UNEP found. The emissions decrease documented in the report is relative to levels projected in 2021, not a net reduction. While methane emissions were on track to increase by 13% by 2030, that would fall to 5% if nations follow through on pledged cuts. Overall, global methane emissions continue to rise, reaching approximately 352 million tonnes in 2020 and projected to hit 369 million tonnes by 2030 under current legislation. “If countries fully implement their existing methane plans submitted as of June 2025, global emissions could fall by about 8% this decade,” Otto said. “That would constitute the largest and most sustained decline in methane emissions ever recorded. So it works, but it doesn’t work fast enough.” The report’s modelling does not account for the United States reversing its methane commitments. While the US was once a leading nation in advocating methane emissions cuts and a core author of the 2021 pledge in Glasgow, the Trump administration has rolled back domestic methane policies and pressured the European Union to delay implementation of new methane emissions regulations that would increase reporting transparency. Some US states, including California, have maintained stricter methane reporting requirements. Agriculture, energy and waste lead methane-emitting sectors Global anthropogenic methane emissions in the current policies scenario, 1990–2050, million tonnes per year The UNEP report found that agriculture accounts for 42% of global methane emissions, the energy sector 38%, and waste 20%. The G20 countries plus the European Union and several other developed nations are responsible for 65% of total emissions, with China taking the top spot. The energy sector offers the largest mitigation opportunity, UNEP said, with 72% of technically feasible reductions by 2030 concentrated in oil, gas and coal operations. More than 80% of the total reduction potential across all sectors can be achieved at costs below $36 per tonne of CO2 equivalent, with many fossil fuel measures actually profitable because they capture gas that can be sold rather than vented or flared. Inger Andersen, executive director of UNEP, said “reducing methane emissions is one of the most immediate and effective steps we can take to slow the climate crisis while protecting human health.” Chloe Brimicombe, a climate scientist at the Royal Meteorological Society, linked methane emissions to more frequent and intense heatwaves, which kill nearly 600,000 people annually. “Heat puts immense stress on the body, particularly for children, older people and those with chronic illness,” she said, describing methane cuts as a “fast and effective way to help protect communities from heat-related illness and deaths.” “Reducing methane decreases the precursors of ground-level ozone, reducing cardiovascular and respiratory disease immediately,” said Courtney Howard, an emergency physician and chair of the Global Climate and Health Alliance. “Cutting methane is a win-win for health and health systems now and into the future.” ‘On the radar’ Global anthropogenic methane emissions under different scenarios, 1990–2050, million tonnes per year. Regional studies “continue to reveal significant underreporting of methane emissions, particularly within the fossil fuel sector,” the report found. Dan Jørgensen, European Commissioner for Energy and Housing, said nearly 90% of satellite-detected emission events still go unaddressed by governments and fossil-fuel companies. Liz Thompson, climate ambassador of Barbados, called reining in these oversights a “matter of survival” for small island nations. “We need oil and gas companies to recognise the importance of cutting methane emissions by stopping flaring and leaks,” she said. “Over the next year, we must advance discussions so that COP31 can perhaps present a concrete proposal to initiate efforts that will lead to a legally binding agreement.” Current methane-focused investment has reached $13.7 billion annually, up 18% in recent years but far below the $127 billion needed by 2030. Measures in the fossil fuel sector could be deployed at little to no net cost, with bills for the energy sector overall representing just 2 to 4% of the industry’s 2023 income, according to the report. “It shows that methane has made it onto the radar and that we’ve gained momentum, that cost-effective solutions exist today, essentially waiting to be brought to scale, and that the benefits are enormous,” Otto said. “We can do it, but we have to act much faster.” China’s participation in COP30 methane summit marks a shift The report launch coincided with a “methane summit’’ co-hosted by Brazil, China and the United Kingdom on the sidelines of COP30. The summit launched a “Super Pollutant Country Action Accelerator” providing $25 million in initial funding for seven developing countries to establish dedicated national methane units, modelled on the successful Montreal Protocol ozone programmes. China’s participation marked a significant diplomatic development, as Beijing co-hosted the event despite not being a signatory to the Global Methane Pledge. The country is the world’s largest methane emitter, primarily from its massive coal mining sector. “The summit not only underscores the critical role of controlling methane and other non-CO2 greenhouse gas emissions in the global response to climate change, but also encourages all parties to share the policies and actions they have taken in the emission reduction process,” Huang Runqiu, China’s environment chief, said at the summit. “Climate change is a global challenge, and addressing it requires concerted efforts from the entire world.” The UK also led a statement signed by Canada, France, Germany, Japan, Kazakhstan and Norway committing to drastically reduce methane emissions in the fossil fuel sector, including ending routine flaring and venting by 2030 and developing a “near-zero methane intensity marketplace” by 2026 to use trade measures to reward low-emission producers. “The global methane pledge has had an impact. It supported the reshaping of national priorities,” Otto said. However, she noted the report had to exclude the latest round of national climate plans submitted after June 2025 from its modelling. “Obviously, we have seen new coming in, but we had to do the modelling at one point, and so that became our cut-off.” Beyond 2030, the report warned that technical fixes alone will prove insufficient. Meeting 1.5C or 2C warming targets will require combining methane controls with broader energy decarbonisation and demand-side measures, including dietary shifts and reduced food waste, potentially cutting emissions 53% below 2020 levels by 2050. “We can still make it,” Otto said. “But it will take a whole lot of additional effort. It’s not possible if we do it half-heartedly.” With five years remaining until the 2030 target, “the choices made in the next five years will determine whether the world seizes this opportunity, unlocking cleaner air, stronger economies, and a safer climate for generations to come,” UNEP concluded. Image Credits: Clean Air Task Force . Former DOGE Official Driving US Bilateral Health Agreements With African Countries 17/11/2025 Kerry Cullinan US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenyan Treasury and health officials. The United States government is moving rapidly to secure Memorandums of Understanding (MOU) with African countries that offer limited health aid for five years in exchange for 25 years’ access to countries’ data about “pathogens with epidemic potential”. Some commentators have described the terms of the bilateral MOUs as “extractive” as they fail to offer African countries access to the health products that might be developed from the pathogen material that they share. The process is being driven by Brad Smith, formerly one of the leaders of Elon Musk’s Department of Government Efficiency (DOGE), who was responsible for implementing deep cuts to the US Health and Human Services (HHS) department. Smith is now a global health advisor in the US State Department, overseeing the reorganisation of the US President’s Emergency Plan for AIDS Relief (PEPFAR) and health grants from the now defunct US Agency for International Development (USAID). He was part of the US delegation that met Kenyan health and finance officials last week to discuss its MOU. So too was Bethany Kozma, a former USAID official during the first Trump administration and a fervent anti-abortion campaigner. She is currently chief advisor for policy and strategy in the HHS Global Affairs Office. Bethany Kozma, anti-abortion campaigner and chief advisor for policy and strategy in the HHS Global Affairs Office, also attended the meeting with Kenya. Dr Chris Kiptoo, Kenyan Treasury’s Principal Secretary, reported after last week’s meeting that “both countries are finalising a bilateral agreement that aligns Kenya’s health priorities with the United States’ global health objectives, strengthening a partnership that saves lives and builds a more resilient health system for our nation”. Meanwhile, Rwandan Health Minister Dr Sabin Nsanzimana met a US delegation headed by Dr Mamadi Yilla, US State Department deputy assistant secretary for health diplomacy, last week to discuss a new MOU. Rwandan Health Minister Dr Sabin Nsanzimana and Dr Mamadi Yilla, US deputy assistant secretary for global health diplomacy and other officials. Smith also led the US delegation to Zambia on Monday (17 November), where he met Zambia’s Health Minister, Dr Elijah Muchima, and Finance Minister Situmbeko Musokotwane. The meeting aimed to “chart a new course for US health assistance to Zambia”, according to the US Embassy in Zambia. “The new approach envisions both governments committing to funding levels and health outcome performance objectives in order to accelerate the transition from an aid-dependent health sector to a Zambian government-led health system that is able to sustainably meet the health needs of the Zambian people,” according to the US media release. US official Brad Smith and Zambian Finance Minister Situmbeko Musokotwane. Extensive access to data The MOUs include clauses that would give the US extensive access to country health databases and contain punitive measures for countries that fail to provide this access or pathogen information, including unspecified “changes in the planned assistance” or total discontinuation of aid. Conversely, those that meet targets may get unspecified rewards. While the agreements contain a list of targets (“outcome metrics) for reducing HIV, TB, malaria, maternal and under-five mortality, and increasing measles vaccinations, details about how these will be achieved are scanty. In contrast to the health services section, the “surveillance and outbreak response” section is far more detailed, with budget allocations and staff numbers. For instance, Zambia is expected to employ “1,723 field epidemiologists” in 2026 at its own expense to meet its outbreak surveillance and pathogen-sharing requirements, according to a draft seen by Health Policy Watch. The US also notes in the draft Zambian MOU that it is making a $50 million cut to its previous commitment of $120 million in funding for antiretroviral (ARV) medicine and HIV tests due to “historic theft”. This relates to a 2021 scandal where it emerged that ARVs donated to Zambia were being sold in pharmacies. Countries need the capacity to detect disease outbreaks within seven days and report to the US on these within a day of an outbreak being detected, according to the MOUs. Twenty-five years’ access for five-year grants Countries also have to commit to signing a 25-year “specimen sharing agreement”, although the MOUs only cover a five-year grant period. This agreement will cover “sharing physical specimens and related data, including genetic sequence data, of detected pathogens with epidemic potential for either country within five days of detection”. However, an annex that is supposed to set out the “elements” of the agreement is blank. Bizarrely, the MOUs also want governments to commit to a 25-year “data sharing arrangement” for “exchanging data on the long-term performance of this MOU and for accountability to the United States Congress for appropriated funds”. However, the country grants will only run from 1 April 2026 until 2030. Author Emily Bass published a template for this data-sharing arrangement over the weekend, saying that it “reveals the unprecedentedly extractive nature of these ongoing negotiations”. The US wants access to a range of data, including electronic medical records, health management and information systems, and outbreak response and surveillance data systems. “This agreement affords the US at-will visibility into digital systems, including those, like electronic medical records, that include personal identifiable information,” Bass notes. In the audit section, the MOUs stress that countries need to provide the US with “any data access or information needed to monitor compliance with applicable legal requirements, including to confirm no US government funding is being used for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions”. The MOU concludes by noting that it is not a legally binding document but “a record of the intentions of the parties”. Bypassing WHO? Member states started to negotiate a pathogen access and benefit-sharing system at the WHO headquarters in Geneva recently. By placing itself at the centre of rapid information-sharing about dangerous pathogens, the US appears to be attempting to usurp the World Health Organization (WHO). WHO member states are currently negotiating a Pathogen Access and Benefit Sharing (PABS) system that unite countries, pharmaceutical companies and non-profits in a single process aimed at speedily sharing information and developing counter-measures for pathogens that can cause pandemics. The US and Argentina are the only countries that have opted out of these negotiations. However, if the US is the gatekeeper of pathogen information via these MOUs, this likely to fracture and slow down the global response to pandemics. In addition, US companies could also get the first shot at developing vaccines, therapeutics and diagnostics for these pathogens. Aggrey Aluso of Resilience Action Network Africa (RANA) warned that while governments “should explore deals that could benefit the lives of their people and their economy, such deals should not be extractive”. “Global health security cannot be built on coercive conditionalities,” Aluso told Health Policy Watch. “True preparedness demands equity, respects data sovereignty, and is grounded in solidarity — not transactions that deepen inequities and silence the voices of those most affected. The current version of the proposed MOUs need an inclusive, equity-centred approach.” Health Systems Are Unprepared for The Climate Crisis 14/11/2025 Stefan Anderson The synthesis report follows the launch of the Belém Health Action Plan at COP30, a voluntary best practice framework to assist governments in adapting their health systems for climate change. Nations worldwide must finance and implement climate adaptation measures for health systems or risk losing millions of lives as extreme weather, rising temperatures, and intensifying heat threaten healthcare access for nearly half the global population, according to a report published Friday by the World Health Organization and Brazil. The special report, released at the COP30 summit in Belém, follows Thursday’s launch of the Belém Health Action Plan, which won backing from roughly two dozen countries but secured no financial commitments from governments. The only funding to support the plan came from philanthropies: a $300 million one-time grant. The report estimates health system adaptation needs at $22 billion per year by 2035. “The climate crisis is a health crisis – not in the distant future, but here and now,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This special report provides evidence on the impact of climate change on individuals and health systems, and real-world examples of what countries can do – and are doing – to protect health and strengthen health systems.” The past decade has been the hottest on record, with global temperatures exceeding 1.5°C above pre-industrial levels for the first time in 2024. Updated Climate Tracker projections published at the UN climate summit on Wednesday show the world on track for 2.5°C of warming, while the UN Environment Programme projected last week that a business-as-usual scenario has the world heading for 2.8°C. Every fraction of a degree endangers millions. “Many health systems are fragile, lacking climate-trained personnel, resilient infrastructure and adequate surveillance,” said Simon Stiell, executive secretary of the UN Framework Convention on Climate Change. “Watching super typhoons and flash floods rip through hospitals and local health clinics is heartbreaking, but lamenting is not a strategy. We need real solutions.” Simon Still, executive secretary of the UNFCCC, addresses COP30’s opening plenary. “The real challenges people face, such as extreme heat, air pollution, infectious diseases, mental health and food insecurity – humanity can only win this global climate fight if we connect stronger climate actions to people’s top priorities in their daily lives, and there are few higher priorities than our health,” Stiell said. The report does not present new evidence, functioning instead as a synthesis of the best available science and data on the risks posed to unprepared health systems by climate change, drawing on academic literature, government and UN reports, and real-world case studies. “Recent tragedies show that now is the time to implement policies and actions that address the impacts of climate change on health,” said Alexandre Padilha, Brazil’s health minister. “The Belém Health Action Plan and this report offer countries the tools they need to turn scientific evidence into concrete action.” As storms batter coastlines, floods displace communities, and droughts fuel conflict and hunger, the report paints a picture of health systems under mounting strain. The familiar but alarming statistics form the case to policymakers to invest in adaptation and join the Belém plan. More than 540,000 people now die annually from extreme heat, a 63% rise since the 1990s. Between 3.3 and 3.6 billion people live in regions highly vulnerable to climate change. One in twelve of the world’s 200,000 hospitals face the risk of total shutdown due to extreme weather events under high-emissions scenarios, with more than 70% of at-risk facilities located in low- and middle-income countries. Hospitals and health facilities are also 41% more likely to suffer damage from extreme weather events than in 1990. “Climate change is an unavoidable reality that challenges public health and adds pressure on already overwhelmed systems,” Padilha said, calling policies to protect the health sector one of the “most strategic decisions of the 21st century.” “Protecting lives, reducing inequalities, and bolstering the resilience of health systems are no longer just goals – they have become ethical and democratic imperatives,” he said. Mitigation left out of the main Belém text Brazil’s COP30 presidency chose the Amazon city of Belém in an effort to remind negotiators of the planet they are fighting to protect. While the report and Belém Health Action Plan focus on preparing health systems for climate impacts, the synthesis document draws a clear conclusion about what would most protect those systems: cutting emissions. “The evidence is clear: urgent and sustained mitigation across all sectors is the single most important health adaptation intervention,” states the executive summary. “There are profound physical, financial, and technological limits to adaptation, and health systems cannot remain resilient in a world of unchecked warming.” By reducing emissions, health systems would face less extreme weather events, fewer heat deaths, and smaller disease burdens, making adaptation needs less severe in the first place. That finding sits awkwardly with the Belém Health Action Plan itself, which contains no references to phasing out fossil fuels, the main driver of climate change. The fossil fuel omission came at the explicit instruction of the Brazilian COP30 presidency, according to people familiar with the negotiations, likely to open the door for more nations to sign on who will not commit to language on fossil fuel phase-out. What the report identifies as “the most effective measure” to protect health systems is excluded from the political Belém framework, which requires endorsement from governments, instead relegated to a supporting document with no political weight. “When COP30 delegates leave Belém, success will be measured by the courage governments have demonstrated to act on what is already known: that fossil fuels are destroying people’s health,” said Jeni Miller, health lead at the Global Climate and Health Alliance. “To ignore these realities would be to betray both science and humanity.” A $20 billion gap Adaptation needs for health systems estimated in the COP30 special report. Direct health sector adaptation interventions will require more than $22 billion annually by 2035, according to the report, approximately 7% of total adaptation financing needs in climate-vulnerable countries. Current health-specific climate finance reaching those countries totals around $500 to $700 million annually, representing 2% of adaptation funding and 0.5% of multilateral climate finance. Climate and health finance has grown considerably in recent years, rising tenfold from less than $1 billion in 2018 to $7.1 billion in commitments between 2018 and 2022, according to analysis published earlier this year by the Rockefeller Foundation, WHO and other partners. In 2022, this included $4.8 billion from bilateral donors, $600 million from multilateral development banks, $1.5 billion from multilateral health funds, and $130 million from philanthropies. The share of climate finance targeting the health sector increased from 1% in 2018 to 9% in 2022, the only sector apart from education to see an increase. Yet these flows remain far below estimated needs, and more than 90% of health adaptation funding from development banks arrives as loans rather than grants. “The evidence is clear that we have been too slow to act on climate change and we are now ill-equipped to cope with rising temperatures across the world,” said Alan Dangour, health and climate lead at the Wellcome Trust. The report identifies persistent gaps in readiness. Only 54% of national health adaptation plans assess risks to health facilities. Fewer than 30% of health adaptation studies consider income, 20% consider gender, and less than 1% include people with disabilities. More than 60% of National Adaptation Plans have no formal tracking or evaluation in place. “Extreme heat, air pollution and infectious disease all hit the most vulnerable hardest: children, pregnant people, older adults, outdoor workers, and communities with the fewest resources,” Dangour said. “At COP30 and beyond, governments must act on the science – cut emissions, invest in adaptation, and put health at the heart of climate action. Lives, economies, and our future depend on the solutions we deliver now.” Image Credits: COP30, COP30. How Intimate Partner Violence Affects Children 14/11/2025 Disha Shetty Children’s health suffers in households where their mothers are abused. Noma Bolani has a clear memory of her abusive father stopping the car in the middle of the highway in Durban, South Africa and asking her mother to get out. She was just six years old, but Bolani followed her mother out of the car, and together they sought help from a passing motorist. Bolani is now 38, and has anxiety stemming from early childhood experiences related to growing up with an abusive father and witnessing her mother being at the receiving end of emotional and financial violence. Ayesha*, 34, from New Delhi, India, grew up watching her mother being subjected to physical, emotional and financial violence from her father. He would sometimes also resort to silent treatment that would last weeks, refuse to pay school fees for Ayesha and her sister and resort to physical violence using belts, shoes and, at times, utensils. Ayesha suffers from Polycystic Ovary Disease (PCOD) that affects the regularity of her periods and causes hormonal changes. Her doctor believes the stress she was subjected to as a child played a significant role in worsening her PCOD. Like Bolani, Ayesha also carries mental health scars from watching violence directed at her mother. When mothers are at the receiving end of violence, it can make their children physically ill, according to a growing body of research. Impact on children’s health Health data from 37 countries in sub-Saharan Africa found that children under the age of five whose mothers experienced intimate partner violence (IPV) were more likely to develop diarrhoeal disease and symptoms of acute respiratory infections, according to a study published in The Lancet last year. It called for tailored interventions to address childhood morbidity and mortality attributed to IPV in “priority countries” – Burkina Faso, Burundi, Chad, Comoros, Gabon, Liberia, Nigeria, Sierra Leone, South Africa, and Uganda. “The most important thing is actually the cumulative effect,” said Abel Dadi, lead author and a social epidemiologist at the Menzies School of Health Research at the Charles Darwin University in Australia. His study looked at exposure to three kinds of violence – physical, sexual and emotional. “When they come together, their effect increases,” he said. Dadi’s team also found a strong link between IPV and stunting in Burundi, and IPV and children being underweight in Burkina Faso, although the results were not consistent across all countries. What is not yet clear is the exact pathway of how IPV directed towards the mother affects a child’s physical health. A mother and newborn at a health center in the Patna district of Bihar, India. Babies’ health and well-being is deeply affected by their mother’s health. Pervasive violence The World Health Organization (WHO) recognizes that violence against women is a major public health issue. Globally, one third (27%) of women experience IPV in their lifetime, according to WHO figures. In sub-Saharan Africa, these rates are even higher, with 45·6% of women experiencing IPV in their lifetime. Young women aged 15 to 19 are the most affected by IPV. By the time they are 19 years old, almost a quarter of adolescent girls (24%) who have been in a relationship have already been physically, sexually, or psychologically abused by a partner, according to WHO data. However, while it is widely accepted that intimate partner violence affects a woman’s mental, physical and sexual health at risk, its impact on children has not received the same attention. But a child’s health and well-being are completely dependent on their mother during pregnancy, and heavily dependent in the early years, so a mother’s health and well-being directly affects her child’s health. The WHO, which developed a toolkit with UN Women to prevent violence against women in 2019, acknowledges that violence against women and against children often occurs in the same household. Psychiatrists like Bessel van der Kolk, who wrote ‘The Body Keeps the Score’, and Gabor Mate, author of ‘The Myth of Normal’, have also brought the lifelong impact of childhood trauma into the public domain, particularly of growing up with abusive parents. But IPV has long been seen as a criminal issue rather than a health issue. In India, for example, hospitals have only recently started to offer health workers training to see it as a public health problem. “I don’t think it is a well-understood field of work in terms of a response from the courts or from the state’s response to children’s rights,” said Julie Thekkudan, South Asia consultant at Equality Now, a global non-profit that advocates for women’s and girls’ rights. Each dot represents a different country in the region. There has been progress, with signs that IPV is reducing in some low- and middle-income countries due to progress in women’s empowerment. The reason women find it hard to leave abusive relationships, especially in the Global South, is that they have been socialized to tolerate violence, according to Thekkudan. In societies that favour sons and devalue daughters, girls are socialized into believing that their “purpose in life is to get married”, she explained. Staying in a marriage, even if it is abusive, and seen as part of “making sure that your family honor is maintained”, Thekkudan added. That, in addition to the fact that women don’t always have the financial ability to leave, makes it a harder choice. Dadi said that any intervention design on maternal health should consider intimate partner violence as well as the mental health of the mother. Currently, most of these kinds of interventions are concentrated in high-income countries, according to research. On average, countries that do better on gender equity indexes usually also experienc lower levels of violence against women, according to takeaways published in The Lancet. But a woman’s higher economic status can also make her vulnerable. One study from sub-Saharan Africa showed that women’s employment, especially if they were the sole earners or if they earned more than their male partner, was linked to a higher level of intimate partner violence. Any solution “has to be a multi-pronged, multi-level”, said Thekkudan. “I don’t think there is one solution that will change the entire system or the structure.” *Name changed to protect identity Image Credits: Photo by Alex Pasarelu on Unsplash, BMGF, World Bank. Brazil Wins Limited Backing for COP30 Climate-Health Plan, But Nations Commit No Finance 13/11/2025 Stefan Anderson Belém framework wins backing from two dozen nations, but health remains outside formal UN climate negotiations. Brazil launched a sweeping climate-health action plan on Thursday, named after the COP30 host city in the Amazon, winning initial endorsements from roughly two dozen countries for a voluntary framework calling on nations to strengthen disease surveillance, build climate-resilient infrastructure, and protect vulnerable populations from the health impacts of rising temperatures and extreme weather. The Belém Health Action Plan outlines 60 action items across surveillance systems, evidence-based policies, and health innovation to address the health risks facing 3.3 billion people globally affected by the climate crisis. “The climate crisis is one of the most significant health challenges of our time,” states the plan, developed by Brazil’s health ministry in consultation with the WHO. Countries that endorse the voluntary framework will report their progress through UN climate negotiations during the second Global Stocktake at COP33 in 2028. The World Health Organization calls climate change “the greatest single risk to humanity,” and the World Bank estimates it could cause up to 15.6 million deaths between 2026 and 2050, with health impacts costing $8.6 to $15.4 trillion by mid-century. Initial supporters include European Union states such as France and Spain, small island nations like Tuvalu, African countries from Congo to Zambia, and others including Canada, Japan, the United Kingdom and Malaysia. Brazil’s health minister Alexandre Padilha said the plan had received backing from more than 80 nations and institutions, though the vast majority comprises civil society organisations like the Global Climate and Health Alliance, global health actors including Medicines for Malaria Venture and Drugs for Neglected Diseases Initiative, and UN agencies such as UNFPA, UNICEF and UNITAID. “We expect to have more by the end of the day and the end of the COP,” Padilha said, adding the presidency would continue “trying to engage and mobilise” more countries. “There’s a very strong commitment from our government and ministers of health in this plan.” Delegates gather in the plenary hall of COP30 in Belem for the launch of the Brazil-WHO-led health-climate adaptation plan. The voluntary nature of the framework and broad support for the Alliance for Transformative Action on Climate and Health (ATACH) — a WHO-led initiative launched at COP26, which now counts 101 members — suggest endorsements will likely grow, but implementation remains uncertain. WHO will serve as the secretariat for the Belém plan, measuring outcomes through the ATACH framework. The sole explicit dissent Thursday came from Egypt, part of the Baku coalition of previous COP presidencies that helped draft the plan. Egypt’s health minister expressed willingness to join but voiced “concern about the reference to the inclusion of LGBTIQ+ individuals, as such patterns fall outside the nationally recognised policy frameworks in the cultural context of Egypt.” Other coalition members, the United Arab Emirates and Azerbaijan, expressed political will to continue discussions but stopped short of endorsement, instead noting they had “contributed” and “noted with interest” the framework’s goals. “We have to look at the impact of climate change, one of the main threats to public health in the world today,” Padilha said. “Scientific evidence has shown clearly that the climate crisis is first and foremost a crisis of public health throughout the world.” “The time of warnings has finished. Now we are living in a time of consequences,” he added. “The climate has already changed, so we have no alternative but to have public policies to adapt and face climate change.” No money from nations The voluntary adaptation framework was endorsed by around countries but faces billions in funding shortfalls. The launch came with no new financial commitments from endorsing nations. The sole funding announcement came from a coalition of philanthropies including the Gates Foundation, Wellcome Trust, and Rockefeller Foundation: a $300m one-time grant to support climate-health adaptation measures. That figure is dwarfed by estimates that low- and middle-income countries require at least $11 billion annually just for basic health adaptation covering only disease control for malaria, dengue, diarrheal diseases, heat-related mortality, and essential surveillance improvements, according to the UN Environment Programme. “Health systems, already stretched and underfunded, are struggling to cope with these growing pressures, and most are still unprepared for what is coming,” said Marina Romanello, executive director of the Lancet Countdown at University College London. “Existing finance falls short by billions. Without urgent investment, we will not be able to protect populations from escalating climate impacts.” The $11 billion annual UNEP pricetag excludes respiratory illnesses, malnutrition, mental health services, additional infectious disease programs, workers’ health protection, supply chain adaptation, and health system decarbonisation — most of what the Belém plan contains. The UNFCCC estimates global health adaptation will require $26.8 to 29.4 billion annually by 2050. Current health-specific climate finance reaching those countries totals perhaps $500 to $700 million annually, representing 2% of adaptation funding and 0.5% of multilateral climate finance. “With regards to finance, that reality is that we have a deficit that is quite colossal,” said Carlos Lopes, Special Envoy for Africa to the COP30 Presidency. A WHO survey of National Health Adaptation Plans found all included climate-health risks. But just 28 nations worldwide have completed such plans. As temperatures continue rising and extreme weather events intensify, pressure mounts for health system adaptation at a moment when global health financing faces unprecedented strain. Overall development assistance for health dropped 21% from nearly $50 billion in 2024 to $39 billion in 2025, driven largely by US withdrawal from global health programs. The WHO itself faces budget shortfalls of 15-20%. Climate-health financing has grown from less than $1 billion globally in 2018 to $7.1 billion in 2022, the only aid sector to grow in that time apart from education, according to Rockefeller Foundation analysis. But substantial portions arrive as loans: 24% of bilateral climate-health funding and more than 90% from the Asian Development Bank and Inter-American Development Bank. Many developing countries now spend more on servicing debt than on healthcare, with low-income countries spending roughly 300 times less per capita on health than wealthy nations. That finance shortfall impacts their ability to implement adaptation plans like the Belem Framework: A 2021 WHO survey found that while half of the countries reported having national health-climate strategies, less than a quarter achieved high implementation levels. Insufficient financing was identified as the key barrier by 70% of responding countries. Health’s struggles mirror wider climate adaptation finance gaps. At COP26 in 2021, developed countries pledged to triple overall adaptation finance from 2019 levels to at least $120 billion per year by 2025. Actual flows across all sectors totalled $26 billion in 2023. Money will determine whether Belém becomes an implemented plan or another symbolic declaration. Without tens of billions in annual funding, it will likely follow previous COP health commitments that failed to translate rhetoric into action. “The Belém Health Action Plan gives us the blueprint,” said Simon Stiell, executive secretary of the UN Framework Convention on Climate Change. “What we need now is sustained, coordinated and well-financed action to turn its promises into protection for all.” What’s the plan? Launch event for the Belem Health Action Plan at COP30. The Belém plan functions as a framework of best practice recommendations for adapting health systems to the climate crisis, containing no legally binding requirements or targets. Instead, the document outlines recommendations organized around surveillance systems, policy interventions, and infrastructure overhauls that officials say are essential to protecting billions from climate-driven health crises. The one specific requirement: Countries that endorse it will report progress through the Paris Agreement’s Global Stocktake by COP33 in 2028, with no enforcement mechanisms or compliance requirements. “For decades, WHO has been calling for action to adapt health systems and build resilience to climate change,” said Tedros Adhanom Ghebreyesus, WHO director-general. “The Belém health action plan is how we can do that.” “Health systems themselves are affected by climate change, compromising their ability to deliver life-saving care when people need it most,” he said. “There can be no healthy people on a sick planet.” The first focus: building the capacity to see threats coming. The framework calls for climate-informed health monitoring that links meteorological agencies with health institutions, using predictive modelling to trigger early warnings before heat waves, floods, or disease outbreaks overwhelm communities. Surveillance should also track which populations face the greatest risks, data officials say is often missing. The second area addresses policy interventions to protect communities, including clean energy and sustainable transport, heat protection for workers, mental health support woven into climate response, and targeted measures for Indigenous peoples and persons with disabilities. ”For many countries, adaptation is a question of survival in the short run. If you don’t adapt, it threatens the coverage of health services of patients and professionals who are already facing adverse conditions,” Padhila said. “If we don’t adapt, we are going to increase inequality. In short, if you don’t adapt, we will kill people.” Water & power “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. Finance will determine whether the Belém framework’s most ambitious element, climate-resilient infrastructure, can be delivered. The plan envisions health facilities built to withstand climate shocks, renewable energy powering clinics, telehealth platforms extending care, and strategic stockpiles of temperature-stable medicines and vaccines. It calls for “integrated methodologies linking environmental, meteorological, social, climate and health monitoring data” with real-time surveillance and digital technologies as “structural components.” The problem: roughly 100,000 health facilities in sub-Saharan Africa lack reliable electricity, affecting nearly a billion people worldwide. Up to 70% of medical equipment in developing countries sits unused due to power failures. Cold chains for vaccines, digital surveillance systems, early warning platforms, and telehealth services all depend on reliable power that serving populations don’t have. Closing the healthcare electrification gap by 2030 would cost $4.9 billion, about $5 per person affected over six years. That’s less than one year of current global climate-health spending. “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. “It is very important we have the policies… working on the value chains of electricity to make sure that our babies, who are getting born without electricity,” have access to care. Water and sanitation infrastructure are equally critical, she noted. “If we bring water, we bring sanitation. There is already a disease that we will put away. We can tell our boys and girls to wash their hands, but how could they do it if there is no water at the school?” Just three nations have completed all four ATACH assessments as of 2025. The Belém plan’s success will depend not just on building infrastructure, but on countries’ ability to track and report progress. WHO will measure implementation through ATACH, its Alliance for Transformative Action on Climate and Health, which already requires members to complete vulnerability studies, adaptation plans, emissions inventories, and decarbonization roadmaps. The record so far suggests those demands exceed many countries’ capacity. Four years after ATACH’s launch in 2021, only three countries—France, Japan, and the UK—have completed all four assessments. Across 88 countries with available data, roughly 35-40% completed vulnerability assessments and 30% finished adaptation plans. In Africa, fewer than 10 of 29 ATACH members have completed vulnerability assessments. The Belém plan now adds reporting requirements on top of those existing gaps: tracking mental health impacts, monitoring workers’ heat exposure, establishing community resilience programmes, and climate-proofing supply chains, all by 2028. That creates an impossible bind. France, Japan, and the UK have the technical capacity and resources to meet these demands. Many other countries lack not only the expertise for complex reporting systems, but the basic infrastructure, electricity and water, that the plan assumes as a foundation. “Finance is still the bottleneck for us,” Princess Djigma said. Fossil fuel phase-out excluded Delegates arrive for the opening day of COP30 on the edge of the Brazilian Amazon. Notably absent from the plan is any reference to phasing out fossil fuels, the main driver of climate change and the resulting heat, extreme weather and air pollution killing approximately 8m people annually from respiratory and cardiovascular diseases. The omission came at the explicit instruction of the Brazilian COP30 presidency, according to people familiar with the negotiations. The exclusion comes as the International Energy Agency warned Wednesday that global oil and gas demand will rise for the next 25 years if countries do not change course. Until this year, all of the Paris-based body’s modelling assumed fossil fuel consumption would peak this decade. “Climate change is declining — and declining rapidly — in the international energy policy agenda,” said Fatih Birol, the IEA’s executive director. “And this is happening while 2024 was the hottest year in history.” Fifteen countries allocated more resources to fossil fuel net subsidies than their entire national health budgets. Birol’s findings align with the Lancet Countdown report published ahead of the summit, which found the 100 largest oil and gas companies have production strategies that put them on track to exceed their share of production consistent with 1.5 °C of heating by 189% in 2040, up from 183% in March 2024. Private bank lending to fossil fuel activities surged 29% to $611 billion in 2024, exceeding green sector lending by 15%. Some 73 of 87 countries reviewed provided net explicit fossil fuel subsidies in 2023, allocating nearly $1 trillion in direct support. Including indirect subsidies, that figure rises to over $7tn, according to the International Monetary Fund — more than governments spend annually on education and about two-thirds of what they spend on healthcare. The declining political attention extends to international engagement: Mentions of health and climate change by governments in their annual UN General Assembly statements declined from 62% in 2021 to 30% in 2024, according to the Lancet Countdown. “Record deaths from climate-driven wildfires in 2023 show that there’s no adaptation without mitigation,” said Nina Renshaw, head of health at the Clean Air Fund. “Ministries of Health and Finance won’t be able to bail hospitals and clinics out of the climate emergency if governments don’t stop the emissions which are already causing unprecedented harm.” ‘More than dialogue’ Delegates convened for the first-ever Health Day at a UN climate summit in Dubai. The Belém plan follows a pattern established at recent climate summits: the COP28 Dubai Health Declaration signed by 143 countries, the Baku Coalition for Climate and Health launched last year, and efforts stretching back to Glasgow in 2021. Like those efforts, Belém is a non-binding, voluntary process taking place outside formal UN negotiations. Criticisms of the outcomes of Dubai and Baku describe their outcomes as symbolic gestures that generate attention but fail to secure funding, sustained commitment, or implementation. Officials on Thursday repeatedly stressed the need to break the holding pattern. “This gathering must be more than dialogue,” said Jarbas Barbosa, director of the Pan American Health Organization. “It must galvanise collective action and inspire new policies dedicated to protecting everyone’s health from the worsening effects of climate change.” “The climatic crisis is fundamentally a health crisis,” Barbosa said. “We are not talking any more about distant or possible threats. Climate change is a present and growing reality.” Whether the Belém framework can overcome the obstacles that have stymied previous declarations — insufficient financing, limited technical capacity, competing priorities — remains uncertain. But Padilha argued the world has no choice but to try. “We are faced with a dilemma: we either continue to speak and speak and talk, or we can walk the walk and make the political commitment to do so,” he said. “We cannot accept the erosion of multilateralism in global health. Those who deny multilateralism are surrounding us. We will not listen to them.” Image Credits: COP30, COP30, COP30, COP30, COP30, COP30, WHO . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Experts Outline How To Strengthen Trusted Health Knowledge Worldwide 21/11/2025 Maayan Hoffman Global health knowledge is expanding faster than ever, but so are confusion and inequity over who can access trustworthy information and use it to improve their lives. In a live recorded discussion at the World Health Summit in Berlin, featured in the latest Global Health Matters podcast, Joy Phumaphi, executive secretary of the Africa Leaders Malaria Alliance, and Monica Bharel, clinical lead for public sector at Google, reflected on how health information has changed and what it will take to make it truly inclusive. Phumaphi recalled a time when there was effectively one global reference point. “Everything was recorded … by hand,” she said, and “you only had one source of information. That was the World Health Organization.” Today, she noted, “there are so many sources of information, and it’s very, very confusing… We have the rogue scientists and the rogue medical practitioners who spread disinformation.” The danger, she added, is that “the sad thing about both misinformation and disinformation is that is always mixed with a little bit of truth… What it does is that it kills people. You know, people who are not vaccinated during COVID died, and we see children who have not had their measles vaccines dying.” Bharel brought the discussion down to the level of people living on the margins, drawing on her experience caring for patients experiencing homelessness in Boston. She argued that “information is also a determinant of health,” but many people lack “the infrastructure they have to get information… the phones, the internet access, the computer access.” Both speakers stressed the need to strengthen trusted channels. Phumaphi pointed to traditional, religious and social leaders as key messengers, saying health actors “should impart the right information to these… leaders, and even perhaps to the influencers.” Digitalization and AI, they concluded, can be part of the solution. Phumaphi called them “a huge opportunity,” saying, “we can reduce poverty, we can reduce ill health… We can bring the disenfranchised into the fold so, but we have to harness this in the right way and make it available to everybody.” Bharel echoed the urgency: “We can close the gap in health equity and bring in those disenfranchised individuals… we can get people the right information at the right time, at the right level, that they can digest it, and we can do this now.” Listen to more Global Health Matters podcasts on Health Policy Watch >> Image Credits: Global Health Matters Podcast. Global Fund Raises $11.4 Billion, Including $4.6 Billion From United States 21/11/2025 Kerry Cullinan The opening of the Global Fund’s Eighth Replenishment Summit, co-hosted by South Africa and the United Kingdom, a high-level, hybrid side event convened on the margins of the G20 Leaders’ Summit. Johannesburg, South Africa, on Friday 21 November, 2025. JOHANNESBURG – The United States pledged $4.6 billion to the Global Fund during its eighth Replenishment Summit in Johannesburg on Friday – a reduction from its previous pledge of $6 billion, but also an indication that it has not abandoned all multilateral global health efforts. The Global Fund has now raised $11,4 billion of its $18 billion target for the next three years – but several key countries and groups, including France, Japan and the European Commission, have yet to pledge. South African President Cyril Ramaphosa, who co-hosted the Replenishment, said that it was a milestone at a time when multilateralism is being “sorely tested”. “Building resilient health systems, scaling up local manufacturing of medicines, diagnostics and therapeutics and securing sustainable financing are vital for the social and economic development of the people of the world who are vulnerable,” said Ramaphosa. “Without a healthy population, nations cannot prosper. It is therefore essential that we close gaps in access to medicines, diagnostics and therapeutics and financing so that every country can protect its people and achieve health equity.” South African President and Replenishment co-host Cyril Ramaphosa United Kingdom Prime Minister Keir Starmer, the other co-host, said this was the first Replenishment to be hosted by countries in the Global North and South. “Since the UK hosted the first Replenishment back in 2002, our shared investments have saved over 70 million lives across more than 100 countries, cutting the combined death rate of these diseases by almost two-thirds,” said Starmer. “Heartbreaking, malaria still kills a child under five years of age every minute, 4,000 adolescent girls and young women still contract HIV every week. TB remains the world’s single deadliest infectious disease, even though we’ve had a cure for almost a century, and the rise of antimicrobial resistance threatens some of the progress that we thought we’d managed,” he added. Starmer praised the growing investment of the private sector in the Global Fund, and the reforms in the development sector enabling countries to drive their own programmes more successfully. UK Prime Minister and Replenishment co-host Keir Starmer Announcing the US pledge via video, Jeremy Lewin, US Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, described the Global Fund as a “critical partner” in advancing his country’s new ‘American First’ strategy. The US had undergone a “rigorous review” of its multilateral commitments, and “left numerous multilateral organisations, including the WHO and Unesco, as they do not work for the American people,” Lewin noted. However, while the Trump administration views “foreign assistance as a tool of US diplomacy” and every taxpayer’s dollar is being assessed in terms of “America First”, the US is “proud of its legacy as the most generous nation in the world”, he added. “The best days of American healthcare leadership are yet ahead. The State Department recently unveiled our new ‘American First’ global health policy, which affirms our commitment to global health but enacts much-needed reforms. “The Global Fund is a critical partner in advancing our America First strategy. It has long advanced the key tenets of our approach, investing much of its resources in scaled procurement of health commodities,” said Lewin. “Under the leadership of [executive director] Peter Sands, we have every confidence that its legacy of excellence will continue,” he concluded. The US pledge is tied to a 1:2 commitment, meaning that every $1 from the US has to be matched by at least $2 from other donors. Last month, Germany announced a €1 billion pledge at the World Health Summit in Berlin (down from €1.4 billion previously). Other substantial donors include Canada, which committed CAD$1.02 billion, the Netherlands, committing €195.2 million; Norway, which committed $200 million; Italy giving €150 million; Ireland increasing its commitment to €72 million, and the Gates Foundation, which pledged $912 million. Image Credits: Global Fund. South Africa May Be Excluded From Future US Grants for HIV Amid Political Row 21/11/2025 Kerry Cullinan South Africa may be excluded from future PEPFAR grants as its relations with the US deteriorate. The United States (US) government has not sought a meeting with South Africa to discuss the resumption of its HIV grant, and it won’t supply the country with the long-acting HIV prevention medication, lenacapavir, amid a deepening political row between the two countries. While US Ambassadors throughout the continent have initiated meetings with African Health Ministers to discuss Memorandums of Understanding (MOU) to set out new terms for the continuation of their US President’s Emergency Plan for AIDS Relief (PEPFAR) grants from April 2026, South Africa has not received such an invitation. “The Department of Health has not received any correspondence from the US government regarding PEPFAR discussions,” Foster Mohale, South Africa’s Health Ministry spokesperson, told Health Policy Watch. A US State Department spokesperson told Health Policy Watch that the US government “is still deliberating future health assistance to South Africa pending broader bilateral discussions”. “The State Department approved the PEPFAR Bridge Plan for South Africa for a six-month implementation period, spanning from 1 October 2025, to 31 March, 2026. The $115 million allocated under this plan supports core life-saving HIV services,” according to the US State Department spokesperson. “The Bridge Plan prioritises service continuity with minimal programmatic changes, focusing on country-specific needs and maximising life-saving impact.” In relation to whether the US would provide lenacapavir to South Africa, a US Embassy spokesperson provided a comment by Jeremy Lewin, Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, stating that the US “will not be contributing doses to South Africa”. “Obviously, we encourage every country, especially countries like South Africa, that have significant means of their own to fund doses for their own population of this innovative American-made drug that Gilead has developed. US-funded doses will not be going to South Africa,” Lewin told a media briefing on 17 November, the day the first 1,000 lenacapavir doses were delivered in Eswatini and Zambia. The US will provide lenacapavir to Eswatini, Kenya, Lesotho, Malawi, Mozambique, Philippines, Uganda, Ukraine, Zambia, and Zimbabwe. Largest HIV+ population A patient getting an HIV test at Witkoppen Clinic, which received PEPFAR for HIV-related services. Around eight million South Africans are living with HIV, around 13% of the population – the largest HIV positive community in the world. In 2024, South Africa received $453 million in PEPFAR funding, and $439 million had been allocated for 2025. But this was suspended when Donald Trump became president on 20 January. In October, the US government approved a $115 million “PEPFAR Bridge Plan” for South Africa for six months from 1 October to 31 March 2026. Relations between the US and South Africa have been rocky since Trump took office, signing an executive order in February to “halt foreign aid or assistance delivered or provided to South Africa”. The order incorrectly claims that South Africa is persecuting white Afrikaners, and has “taken aggressive positions towards the United States and its allies, including accusing Israel, not Hamas, of genocide in the International Court of Justice”. The US has offered white Afrikaners refuge in the US, and Trump has made several disparaging remarks about the country, including at a meeting at the White House with South African President Cyril Ramaphosa. Earlier this month, the US pulled out of the G20 meeting being hosted in South Africa this weekend, with Trump repeating incorrect claims of discrimination against whites as the reason. All 2026 lenacapvir stock bought Lenacapavir, packaged as Sunlenca in the US, where is sells for $42,250 for two injections. The US government and the Global Fund have bought all of Gilead’s 2026 stock of lenacapavir, a twice-a-year injectable that is almost 100% successful in preventing HIV transmission. The Global Fund’s HIV head, Izukanji Sikazwe, told Health Policy Watch that her organisation will supply South Africa and all countries in need with lenacapavir “based on evidence of need”. But eight patient advocacy groups described the rollout of 500 lenacapavir doses each for Eswatini and Zambia as a “public relations stunt” in a media release on Thursday. “Africa and the Global South are being offered merely symbolic handouts, while Gilead and donors shape markets to serve corporate and geopolitical interests, not urgent public health needs,” said Fatima Hassan, director of the Health Justice Initiative (HJI). “By procuring a minuscule number of doses, Gilead can claim that [lenacapavir] is ‘introduced’ in Africa, creating demand and laying the path for commercial bullying instead of introducing the product at actual cost and at scale. This is a profit-seeking, corporate strategy dressed up as solidarity,” she added. Gilead announced in October 2024 that it has authorised six generic manufacturers to sell lenacapavir in 120 low- and middle-income countries, although none are from sub-Saharan Africa. It also excluded several Latin American countries including Brazil and Colombia. The medicine is licensed in the US as Sunlenca for people with drug-resistant HIV, and currently costs $42,250 a year for two injections. The generics are only likely to be available in 2027 at the earliest, and the advocacy groups claim Gilead is “frustrating the speed at which generic entries are possible”, as it has not yet filed an application with India’s drug regulatory authority and has prioritised registration in only 22 countries. ‘Insulting’ The advocacy groups estimate that at least 10 million Africans need lenacapavir to achieve the global goal of a 90% reduction in new HIV infections by 2030, with two million of these being South Africans. However, the US will only provide doses for 325,000 people in 2026 – an “insulting” amount in comparison to the need, said Bellinda Thibela, Health GAP’s International Policy and Advocacy coordinator. “Instead of crumbs, the US should be providing millions of lenacapavir doses, to alter the course of the HIV pandemic and to repair the harms caused by their illegal and deadly cuts to HIV programmes since January,” added Thibela. However, Brad Smith, US Senior Advisor for the Bureau of Global Health Security and Diplomacy, told a media briefing this week that Gilead’s available volume in 2026 is 600,000 doses, but that the US and the Global Fund are committed to buying two million doses. “We anticipate a continued increase in demand and production capability over time to enable us to meet the two million doses sometime in mid-2027,” said Smith, adding that the doses were being split 50/50 between the US and the Global Fund. “We are working out between ourselves exactly who will distribute and procure for which country,” Smith added. Speaking at the same media briefing, Gilead CEO Daniel O’Day said his company was able to “provide Lenacapavir at no profit to Gilead to the countries with the highest burden of HIV”. US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Political decisions Citing the US Executive Order against South Africa, the advocacy groups say that the US has made the country “the target of harsh foreign policy decisions based on the Trump administration’s racism, lies, and conspiracy theories”. Nigeria is also being “pushed out” of lenacapavir support “after being criticised by US government officials, including for refusing to imprison US detainees extracted during US immigration raids”, they claim. “In contrast, Eswatini has accepted the offer of not just the 500 lenacapavir doses ahead of World AIDS Day, but also $5.1 million in funding from the US government in exchange for imprisoning US detainees,” they note. Sibongile Tshabalala, Chairperson of the Treatment Action Campaign (TAC), called for either Gilead to license South African generic companies to make lenacapavir, or for the South African government to “use its lawful powers to issue compulsory licenses”. “Now that the Trump administration has openly tied the global rollout of lenacapavir to a political standoff rewarding ‘compliance’ but punishing African political autonomy and sovereignty, South Africa must step forward with principled global leadership,” the groups add. This story has been updated to include the US State Department’s comment. Image Credits: The Global Fund/ Saiba Sehmi, International AIDS Society, Witkoppen Clinic, Gilead. Global Fund Seeks $14 Billion at Replenishment Summit – With Progress Against HIV, TB and Malaria at Risk 20/11/2025 Kerry Cullinan Deborah and her 10-month-old daughter Catherine at the Baylor College of Medicine Children’s Foundation in Lilongwe, Malawi. Deborah is living with HIV and Catherine is on preventive treatment. JOHANNESBURG – The Global Fund (GF) has only raised $4 billion of its $18 billion budget for the next three years – so much is riding on its Replenishment Summit in Johannesburg on Friday (21 November) as it seeks the balance to advance progress against HIV, tuberculosis (TB) and malaria. The United States has been the largest donor to the Global Fund, contributing around one-third of its budget – but whether it will still contribute generously is an open question, given the Trump administration’s “America First” focus. “We have been in almost constant dialogue with the US since the beginning of the year, and we have not received any stop-work order or any sort of notification that the funding will be stopped,” Francoise Vanni, the Fund’s external relations and communications director, told a media briefing in Johannesburg on Thursday. “We are confident that they will pledge to the Replenishment tomorrow,” added Vanni, pointing out that the US and the GF are working closely to roll out the long-acting HIV prevention medicine, lenacapavir, in several African countries. South Africa and the United Kingdom (UK) are co-hosting the Replenishment, but that did not prevent the UK from cutting its contribution by 15%. The Fund provides 73% of all international financing for TB, 60% for malaria and 24% for HIV. Médecins Sans Frontières (MSF) has described initial pledges as “deeply concerning”. “Germany and the United Kingdom – the only major traditional donors to pledge so far – have both decreased their commitments compared to the last cycle. Specifically, Germany has pledged €1 billion instead of €1.3 billion and the UK has pledged £850 million instead of £1 billion,” MSF noted on Thursday. “No donor has increased their pledge when considering inflation. If other major donors follow Germany and the UK’s examples, the results would be catastrophic for people impacted by TB, HIV, and malaria worldwide,” MSF said. “Failure to meet this [$14 billion] goal would risk catastrophic cuts to essential services, threaten the resurgence of HIV, TB, and malaria – the world’s top three deadliest infectious diseases – and put the financial burden of health care onto the world’s most vulnerable patients.” Members of a spray team prepare their equipment before spraying homes with insecticide to protect families from malaria in Kaukira, Honduras. Saving 70 million lives The GF is the world’s largest funder of global health, and it has saved an estimated 70 million lives since its establishment 22 years ago, according to its Results Report 2025. Around $103 billion has also been saved in reduced hospitalisations, freeing countries’ health systems to address other diseases and other health needs, Vanni noted. While it works in over 100 countries, its effect has been felt primarily in Africa, where 73% of its budget has been spent. In 15 priority countries in sub-Saharan Africa, life expectancy has increased from 49 years old in 2001 to 61 in 2021 – mostly thanks to people with HIV getting access to antiretroviral medicine. In Zambia, for example, life expectancy has increased by 19 years from 43 to 58 years. Since the GF was launched in 2002, AIDS-related deaths have been reduced by almost three-quarters in the countries where the Global Fund operates, and new infections have been reduced by 62%. Without these interventions, AIDS deaths would have increased by 90% and new HIV infections by 75% over the same period. In 2024 alone, Fund-supported TB programmes treated 7.4 million people with TB. Between 2002 and 2023, GF efforts have reduced TB deaths by 40%. Without these, TB deaths would have increased by 134% and TB cases by 40% over the same period. Malaria deaths were reduced by 29% between 2002 and 2023, “even though the population in these countries has increased by 46%”, the Results Report notes. “Without malaria control measures, deaths would have increased by 94% over the same period.” Malaria ‘way off target’ Despite progress, HIV, TB and malaria remain the world’s deadliest infectious diseases. The $18 billion budget could save 23 million lives between 2027 and 2029, avert 400 million new infections and result in a 1:19 return on investment across the three diseases, according to Fund modelling. “Malaria is way off track, with 600,000 people a year dying,” admits Kate Kolaczinski, the Fund’s senior specialist on the disease. “Malaria is the leading cause of outpatient visits in sub-Saharan Africa,” she adds, with 263 million malaria cases in 2023. Between 2002 and 2023, malaria cases in countries supported by the Global Fund increased by 8% “Rising conflict, disruptions from extreme weather events and increasing resistance to antimalarial drugs and insecticides have complicated efforts to combat malaria in 2024,” according to the Results Report 2025. “The goal of ending [malaria] by 2030 looks daunting. Reductions in global health funding could undermine progress against malaria. A widening funding gap, combined with existing crises and an expected population growth in areas at high-risk of malaria, could threaten the lives of millions.” President Duma Boko of Botswana has urged countries to support the Replenishment, noting in an exclusive article for Health Policy Watch: “If the world retreats now, an additional 750,000 children in Africa could die by 2030, and our economies could lose $83 billion in GDP if funding is so low that all prevention interventions are halted.” HIV resurgence? “There’s a risk of HIV resurgence, especially now that we have funding challenges that we’re facing,” says the Fund’s HIV head, Izukanji Sikazwe, pointing out that 9.2 million people living with HIV still need access to treatment. “We are off target for HIV prevention. In 2024, there were 1.3 million new infections. We need a fourfold reduction to meet the 2025 target of 370,000.” Meanwhile, TB surged during the COVID-19 pandemic and but 2024 brought new progress against the disease. “Robust funding commitments in 2025 are absolutely critical to maintaining our momentum against TB and preventing a resurgence that could undo decades of hard-won progress,” according to the Results Report 2025. It describes an “exciting pipeline of innovative tools”, including new TB tests, better treatments and “at least five TB vaccines in phase III efficacy trials”. Private sector contributions While the bulk of the Fund’s budget comes from country contributions, the private sector also contributes – with the Gates Foundation being the biggest and most consistent private donor, contributing $3.91 billion since 2002. “The Global Fund will go down in history as one of humanity’s biggest achievements. It’s also one of the kindest things people have ever done for each other,” according to Gates Foundation chair Bill Gates. The Global Fund’s track record proves it is an excellent investment for our global health dollars. Its work is critical to achieving the goal of ending AIDS, TB and malaria, and making our world a more equitable place for people everywhere.” The Children’s Investment Fund Foundation (CIFF) has significantly increased its contribution recently, focusing on expanding access to lenacapavir by both supporting procurement and the development of generics. John Fairhurst, who heads the Fund’s private sector mobilisation, says that the sector has contributed over $5.3 billion in the past 20 years – often playing a “catalytic role” in innovation. Unlike countries, which give unrestricted funds, private donors can earmark their contributions. Image Credits: Tommy Trenchard/ Global Fund, Global Fund. World Falls Far Short of Methane Cut Targets Halfway to 2030 Deadline 18/11/2025 Stefan Anderson Infrared camera reveals escaped methane emissions from oil rig. Methane leaks from oil and gas make a major contribution to global warming. First UN assessment since the 2021 Glasgow pledge shows methane cuts falling far short of targets needed to meet climate goals. Accelerated action could yield $330 billion in annual benefits by 2030 through improved health and reduced crop losses. Four years after more than 100 countries pledged to slash methane emissions 30% by the end of the decade, a UN assessment has found nations are on track to deliver barely a quarter of that target. The Global Methane Status Report, released Monday at COP30 in the Brazilian Amazon city of Belém, found that current national commitments would cut global methane emissions by just 8% below 2020 levels by 2030. Despite the lack of progress, the 30% target remains technically achievable with increased investment and policy-driven reform, the report found, adding it could yield some $330 billion in benefits to health and cost production, nearly double the cost of investment in methane emissions mitigation. While methane emissions are not a part of formal negotiations in the UN Framework Convention on Climate Change (UNFCC)C, it is the world’s second largest contributor to global warming, after CO2, with a global warming potential 86 times greater. A precursor to ground-level ozone formation, methane is a contributor to air pollution-related deaths as well as reduced crop yields. With an atmospheric lifespan of only about 12 years, reducing methane emissions can yield enormous co-benefits for health as well as reducing the pace of climate change. Collective, non-binding target The Global Methane Status Report produced by the UN Environment Programme is the first comprehensive stocktake of global progress on methane emissions since reduction targets were announced at COP26. The assessment comes as global methane concentrations have reached the highest levels in at least 800,000 years, more than 2.6 times pre-industrial levels, with the gas responsible for roughly one-third of present-day global warming. The new report compiled by the UN Environment Programme is the first comprehensive stocktake since the Global Methane Pledge was launched at the UN climate summit in Glasgow, COP26. The Global Methane Pledge, a non-binding political commitment signed by 159 countries, set a collective global reduction target rather than assigning specific cuts to individual countries or sectors, leaving nations to develop their own strategies and action plans. “Slow climate action means that the multi-decade average of global temperatures will exceed 1.5°C within the next decade,” Ruth do Cutto, deputy climate change chief at UNEP said at a press briefing launching the report. “We must make sure that this overshoot is as short and as low in temperature as possible, and we cannot do that without curbing emissions of methane, which is responsible for one-third of today’s global warming.” Methane’s potency as a greenhouse gas, combined with its relatively short atmospheric lifespan, makes cutting emissions one of the fastest ways to slow near-term temperature rise, often called an environmental “hand brake” by climate experts. “Lack of time is our biggest challenge,” said COP30 President Ana Toni, noting that slashing methane emissions “delivers the fastest results” for slowing warming. Full deployment of what the report calls “maximum technically feasible reductions” could still cut emissions 32% below 2020 levels by 2030, even surpassing the pledge target. These measures would cost an estimated $127 billion annually but deliver benefits valued at $330 billion per year by 2030, including preventing more than 180,000 premature deaths, avoiding 19 million tonnes of crop losses, and reducing global temperatures by 0.2°C by mid-century. “We’re on a highway to hell with the foot on the gas pedal,” Martina Otto, head of the Climate and Clean Air Coalition Secretariat, which produced the report with the UN Environment Programme, said at the launch event in Belém. “If we are heading towards the wall, you don’t just pull the handbrake a little bit. You pull it forcefully and fast. And I think that’s where we are right now,” Otto said. Slow momentum, US wildcard The 159 countries now signed to the pledge, up from just over 100 at launch, represent nearly half of global methane emissions. However, three of the world’s top five emitters remain outside the agreement: China, the largest overall source, India and Russia. China’s participation in a methane summit co-hosted with Brazil and the United Kingdom on the sidelines of COP30 marked a notable diplomatic shift, though Beijing has yet to sign the global methane pledge. Since the pledge’s launch, projected 2030 emissions have improved modestly. Some 127 countries, representing 65% of Paris Agreement parties, now include methane mitigation measures in their latest Nationally Determined Contributions, a 38% increase from pre-2020 levels. New waste management regulations in Europe and North America, combined with slower-than-expected growth in natural gas markets between 2020 and 2024, have lowered forecast emission levels by 14 million tonnes compared with 2021 projections, UNEP found. The emissions decrease documented in the report is relative to levels projected in 2021, not a net reduction. While methane emissions were on track to increase by 13% by 2030, that would fall to 5% if nations follow through on pledged cuts. Overall, global methane emissions continue to rise, reaching approximately 352 million tonnes in 2020 and projected to hit 369 million tonnes by 2030 under current legislation. “If countries fully implement their existing methane plans submitted as of June 2025, global emissions could fall by about 8% this decade,” Otto said. “That would constitute the largest and most sustained decline in methane emissions ever recorded. So it works, but it doesn’t work fast enough.” The report’s modelling does not account for the United States reversing its methane commitments. While the US was once a leading nation in advocating methane emissions cuts and a core author of the 2021 pledge in Glasgow, the Trump administration has rolled back domestic methane policies and pressured the European Union to delay implementation of new methane emissions regulations that would increase reporting transparency. Some US states, including California, have maintained stricter methane reporting requirements. Agriculture, energy and waste lead methane-emitting sectors Global anthropogenic methane emissions in the current policies scenario, 1990–2050, million tonnes per year The UNEP report found that agriculture accounts for 42% of global methane emissions, the energy sector 38%, and waste 20%. The G20 countries plus the European Union and several other developed nations are responsible for 65% of total emissions, with China taking the top spot. The energy sector offers the largest mitigation opportunity, UNEP said, with 72% of technically feasible reductions by 2030 concentrated in oil, gas and coal operations. More than 80% of the total reduction potential across all sectors can be achieved at costs below $36 per tonne of CO2 equivalent, with many fossil fuel measures actually profitable because they capture gas that can be sold rather than vented or flared. Inger Andersen, executive director of UNEP, said “reducing methane emissions is one of the most immediate and effective steps we can take to slow the climate crisis while protecting human health.” Chloe Brimicombe, a climate scientist at the Royal Meteorological Society, linked methane emissions to more frequent and intense heatwaves, which kill nearly 600,000 people annually. “Heat puts immense stress on the body, particularly for children, older people and those with chronic illness,” she said, describing methane cuts as a “fast and effective way to help protect communities from heat-related illness and deaths.” “Reducing methane decreases the precursors of ground-level ozone, reducing cardiovascular and respiratory disease immediately,” said Courtney Howard, an emergency physician and chair of the Global Climate and Health Alliance. “Cutting methane is a win-win for health and health systems now and into the future.” ‘On the radar’ Global anthropogenic methane emissions under different scenarios, 1990–2050, million tonnes per year. Regional studies “continue to reveal significant underreporting of methane emissions, particularly within the fossil fuel sector,” the report found. Dan Jørgensen, European Commissioner for Energy and Housing, said nearly 90% of satellite-detected emission events still go unaddressed by governments and fossil-fuel companies. Liz Thompson, climate ambassador of Barbados, called reining in these oversights a “matter of survival” for small island nations. “We need oil and gas companies to recognise the importance of cutting methane emissions by stopping flaring and leaks,” she said. “Over the next year, we must advance discussions so that COP31 can perhaps present a concrete proposal to initiate efforts that will lead to a legally binding agreement.” Current methane-focused investment has reached $13.7 billion annually, up 18% in recent years but far below the $127 billion needed by 2030. Measures in the fossil fuel sector could be deployed at little to no net cost, with bills for the energy sector overall representing just 2 to 4% of the industry’s 2023 income, according to the report. “It shows that methane has made it onto the radar and that we’ve gained momentum, that cost-effective solutions exist today, essentially waiting to be brought to scale, and that the benefits are enormous,” Otto said. “We can do it, but we have to act much faster.” China’s participation in COP30 methane summit marks a shift The report launch coincided with a “methane summit’’ co-hosted by Brazil, China and the United Kingdom on the sidelines of COP30. The summit launched a “Super Pollutant Country Action Accelerator” providing $25 million in initial funding for seven developing countries to establish dedicated national methane units, modelled on the successful Montreal Protocol ozone programmes. China’s participation marked a significant diplomatic development, as Beijing co-hosted the event despite not being a signatory to the Global Methane Pledge. The country is the world’s largest methane emitter, primarily from its massive coal mining sector. “The summit not only underscores the critical role of controlling methane and other non-CO2 greenhouse gas emissions in the global response to climate change, but also encourages all parties to share the policies and actions they have taken in the emission reduction process,” Huang Runqiu, China’s environment chief, said at the summit. “Climate change is a global challenge, and addressing it requires concerted efforts from the entire world.” The UK also led a statement signed by Canada, France, Germany, Japan, Kazakhstan and Norway committing to drastically reduce methane emissions in the fossil fuel sector, including ending routine flaring and venting by 2030 and developing a “near-zero methane intensity marketplace” by 2026 to use trade measures to reward low-emission producers. “The global methane pledge has had an impact. It supported the reshaping of national priorities,” Otto said. However, she noted the report had to exclude the latest round of national climate plans submitted after June 2025 from its modelling. “Obviously, we have seen new coming in, but we had to do the modelling at one point, and so that became our cut-off.” Beyond 2030, the report warned that technical fixes alone will prove insufficient. Meeting 1.5C or 2C warming targets will require combining methane controls with broader energy decarbonisation and demand-side measures, including dietary shifts and reduced food waste, potentially cutting emissions 53% below 2020 levels by 2050. “We can still make it,” Otto said. “But it will take a whole lot of additional effort. It’s not possible if we do it half-heartedly.” With five years remaining until the 2030 target, “the choices made in the next five years will determine whether the world seizes this opportunity, unlocking cleaner air, stronger economies, and a safer climate for generations to come,” UNEP concluded. Image Credits: Clean Air Task Force . Former DOGE Official Driving US Bilateral Health Agreements With African Countries 17/11/2025 Kerry Cullinan US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenyan Treasury and health officials. The United States government is moving rapidly to secure Memorandums of Understanding (MOU) with African countries that offer limited health aid for five years in exchange for 25 years’ access to countries’ data about “pathogens with epidemic potential”. Some commentators have described the terms of the bilateral MOUs as “extractive” as they fail to offer African countries access to the health products that might be developed from the pathogen material that they share. The process is being driven by Brad Smith, formerly one of the leaders of Elon Musk’s Department of Government Efficiency (DOGE), who was responsible for implementing deep cuts to the US Health and Human Services (HHS) department. Smith is now a global health advisor in the US State Department, overseeing the reorganisation of the US President’s Emergency Plan for AIDS Relief (PEPFAR) and health grants from the now defunct US Agency for International Development (USAID). He was part of the US delegation that met Kenyan health and finance officials last week to discuss its MOU. So too was Bethany Kozma, a former USAID official during the first Trump administration and a fervent anti-abortion campaigner. She is currently chief advisor for policy and strategy in the HHS Global Affairs Office. Bethany Kozma, anti-abortion campaigner and chief advisor for policy and strategy in the HHS Global Affairs Office, also attended the meeting with Kenya. Dr Chris Kiptoo, Kenyan Treasury’s Principal Secretary, reported after last week’s meeting that “both countries are finalising a bilateral agreement that aligns Kenya’s health priorities with the United States’ global health objectives, strengthening a partnership that saves lives and builds a more resilient health system for our nation”. Meanwhile, Rwandan Health Minister Dr Sabin Nsanzimana met a US delegation headed by Dr Mamadi Yilla, US State Department deputy assistant secretary for health diplomacy, last week to discuss a new MOU. Rwandan Health Minister Dr Sabin Nsanzimana and Dr Mamadi Yilla, US deputy assistant secretary for global health diplomacy and other officials. Smith also led the US delegation to Zambia on Monday (17 November), where he met Zambia’s Health Minister, Dr Elijah Muchima, and Finance Minister Situmbeko Musokotwane. The meeting aimed to “chart a new course for US health assistance to Zambia”, according to the US Embassy in Zambia. “The new approach envisions both governments committing to funding levels and health outcome performance objectives in order to accelerate the transition from an aid-dependent health sector to a Zambian government-led health system that is able to sustainably meet the health needs of the Zambian people,” according to the US media release. US official Brad Smith and Zambian Finance Minister Situmbeko Musokotwane. Extensive access to data The MOUs include clauses that would give the US extensive access to country health databases and contain punitive measures for countries that fail to provide this access or pathogen information, including unspecified “changes in the planned assistance” or total discontinuation of aid. Conversely, those that meet targets may get unspecified rewards. While the agreements contain a list of targets (“outcome metrics) for reducing HIV, TB, malaria, maternal and under-five mortality, and increasing measles vaccinations, details about how these will be achieved are scanty. In contrast to the health services section, the “surveillance and outbreak response” section is far more detailed, with budget allocations and staff numbers. For instance, Zambia is expected to employ “1,723 field epidemiologists” in 2026 at its own expense to meet its outbreak surveillance and pathogen-sharing requirements, according to a draft seen by Health Policy Watch. The US also notes in the draft Zambian MOU that it is making a $50 million cut to its previous commitment of $120 million in funding for antiretroviral (ARV) medicine and HIV tests due to “historic theft”. This relates to a 2021 scandal where it emerged that ARVs donated to Zambia were being sold in pharmacies. Countries need the capacity to detect disease outbreaks within seven days and report to the US on these within a day of an outbreak being detected, according to the MOUs. Twenty-five years’ access for five-year grants Countries also have to commit to signing a 25-year “specimen sharing agreement”, although the MOUs only cover a five-year grant period. This agreement will cover “sharing physical specimens and related data, including genetic sequence data, of detected pathogens with epidemic potential for either country within five days of detection”. However, an annex that is supposed to set out the “elements” of the agreement is blank. Bizarrely, the MOUs also want governments to commit to a 25-year “data sharing arrangement” for “exchanging data on the long-term performance of this MOU and for accountability to the United States Congress for appropriated funds”. However, the country grants will only run from 1 April 2026 until 2030. Author Emily Bass published a template for this data-sharing arrangement over the weekend, saying that it “reveals the unprecedentedly extractive nature of these ongoing negotiations”. The US wants access to a range of data, including electronic medical records, health management and information systems, and outbreak response and surveillance data systems. “This agreement affords the US at-will visibility into digital systems, including those, like electronic medical records, that include personal identifiable information,” Bass notes. In the audit section, the MOUs stress that countries need to provide the US with “any data access or information needed to monitor compliance with applicable legal requirements, including to confirm no US government funding is being used for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions”. The MOU concludes by noting that it is not a legally binding document but “a record of the intentions of the parties”. Bypassing WHO? Member states started to negotiate a pathogen access and benefit-sharing system at the WHO headquarters in Geneva recently. By placing itself at the centre of rapid information-sharing about dangerous pathogens, the US appears to be attempting to usurp the World Health Organization (WHO). WHO member states are currently negotiating a Pathogen Access and Benefit Sharing (PABS) system that unite countries, pharmaceutical companies and non-profits in a single process aimed at speedily sharing information and developing counter-measures for pathogens that can cause pandemics. The US and Argentina are the only countries that have opted out of these negotiations. However, if the US is the gatekeeper of pathogen information via these MOUs, this likely to fracture and slow down the global response to pandemics. In addition, US companies could also get the first shot at developing vaccines, therapeutics and diagnostics for these pathogens. Aggrey Aluso of Resilience Action Network Africa (RANA) warned that while governments “should explore deals that could benefit the lives of their people and their economy, such deals should not be extractive”. “Global health security cannot be built on coercive conditionalities,” Aluso told Health Policy Watch. “True preparedness demands equity, respects data sovereignty, and is grounded in solidarity — not transactions that deepen inequities and silence the voices of those most affected. The current version of the proposed MOUs need an inclusive, equity-centred approach.” Health Systems Are Unprepared for The Climate Crisis 14/11/2025 Stefan Anderson The synthesis report follows the launch of the Belém Health Action Plan at COP30, a voluntary best practice framework to assist governments in adapting their health systems for climate change. Nations worldwide must finance and implement climate adaptation measures for health systems or risk losing millions of lives as extreme weather, rising temperatures, and intensifying heat threaten healthcare access for nearly half the global population, according to a report published Friday by the World Health Organization and Brazil. The special report, released at the COP30 summit in Belém, follows Thursday’s launch of the Belém Health Action Plan, which won backing from roughly two dozen countries but secured no financial commitments from governments. The only funding to support the plan came from philanthropies: a $300 million one-time grant. The report estimates health system adaptation needs at $22 billion per year by 2035. “The climate crisis is a health crisis – not in the distant future, but here and now,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This special report provides evidence on the impact of climate change on individuals and health systems, and real-world examples of what countries can do – and are doing – to protect health and strengthen health systems.” The past decade has been the hottest on record, with global temperatures exceeding 1.5°C above pre-industrial levels for the first time in 2024. Updated Climate Tracker projections published at the UN climate summit on Wednesday show the world on track for 2.5°C of warming, while the UN Environment Programme projected last week that a business-as-usual scenario has the world heading for 2.8°C. Every fraction of a degree endangers millions. “Many health systems are fragile, lacking climate-trained personnel, resilient infrastructure and adequate surveillance,” said Simon Stiell, executive secretary of the UN Framework Convention on Climate Change. “Watching super typhoons and flash floods rip through hospitals and local health clinics is heartbreaking, but lamenting is not a strategy. We need real solutions.” Simon Still, executive secretary of the UNFCCC, addresses COP30’s opening plenary. “The real challenges people face, such as extreme heat, air pollution, infectious diseases, mental health and food insecurity – humanity can only win this global climate fight if we connect stronger climate actions to people’s top priorities in their daily lives, and there are few higher priorities than our health,” Stiell said. The report does not present new evidence, functioning instead as a synthesis of the best available science and data on the risks posed to unprepared health systems by climate change, drawing on academic literature, government and UN reports, and real-world case studies. “Recent tragedies show that now is the time to implement policies and actions that address the impacts of climate change on health,” said Alexandre Padilha, Brazil’s health minister. “The Belém Health Action Plan and this report offer countries the tools they need to turn scientific evidence into concrete action.” As storms batter coastlines, floods displace communities, and droughts fuel conflict and hunger, the report paints a picture of health systems under mounting strain. The familiar but alarming statistics form the case to policymakers to invest in adaptation and join the Belém plan. More than 540,000 people now die annually from extreme heat, a 63% rise since the 1990s. Between 3.3 and 3.6 billion people live in regions highly vulnerable to climate change. One in twelve of the world’s 200,000 hospitals face the risk of total shutdown due to extreme weather events under high-emissions scenarios, with more than 70% of at-risk facilities located in low- and middle-income countries. Hospitals and health facilities are also 41% more likely to suffer damage from extreme weather events than in 1990. “Climate change is an unavoidable reality that challenges public health and adds pressure on already overwhelmed systems,” Padilha said, calling policies to protect the health sector one of the “most strategic decisions of the 21st century.” “Protecting lives, reducing inequalities, and bolstering the resilience of health systems are no longer just goals – they have become ethical and democratic imperatives,” he said. Mitigation left out of the main Belém text Brazil’s COP30 presidency chose the Amazon city of Belém in an effort to remind negotiators of the planet they are fighting to protect. While the report and Belém Health Action Plan focus on preparing health systems for climate impacts, the synthesis document draws a clear conclusion about what would most protect those systems: cutting emissions. “The evidence is clear: urgent and sustained mitigation across all sectors is the single most important health adaptation intervention,” states the executive summary. “There are profound physical, financial, and technological limits to adaptation, and health systems cannot remain resilient in a world of unchecked warming.” By reducing emissions, health systems would face less extreme weather events, fewer heat deaths, and smaller disease burdens, making adaptation needs less severe in the first place. That finding sits awkwardly with the Belém Health Action Plan itself, which contains no references to phasing out fossil fuels, the main driver of climate change. The fossil fuel omission came at the explicit instruction of the Brazilian COP30 presidency, according to people familiar with the negotiations, likely to open the door for more nations to sign on who will not commit to language on fossil fuel phase-out. What the report identifies as “the most effective measure” to protect health systems is excluded from the political Belém framework, which requires endorsement from governments, instead relegated to a supporting document with no political weight. “When COP30 delegates leave Belém, success will be measured by the courage governments have demonstrated to act on what is already known: that fossil fuels are destroying people’s health,” said Jeni Miller, health lead at the Global Climate and Health Alliance. “To ignore these realities would be to betray both science and humanity.” A $20 billion gap Adaptation needs for health systems estimated in the COP30 special report. Direct health sector adaptation interventions will require more than $22 billion annually by 2035, according to the report, approximately 7% of total adaptation financing needs in climate-vulnerable countries. Current health-specific climate finance reaching those countries totals around $500 to $700 million annually, representing 2% of adaptation funding and 0.5% of multilateral climate finance. Climate and health finance has grown considerably in recent years, rising tenfold from less than $1 billion in 2018 to $7.1 billion in commitments between 2018 and 2022, according to analysis published earlier this year by the Rockefeller Foundation, WHO and other partners. In 2022, this included $4.8 billion from bilateral donors, $600 million from multilateral development banks, $1.5 billion from multilateral health funds, and $130 million from philanthropies. The share of climate finance targeting the health sector increased from 1% in 2018 to 9% in 2022, the only sector apart from education to see an increase. Yet these flows remain far below estimated needs, and more than 90% of health adaptation funding from development banks arrives as loans rather than grants. “The evidence is clear that we have been too slow to act on climate change and we are now ill-equipped to cope with rising temperatures across the world,” said Alan Dangour, health and climate lead at the Wellcome Trust. The report identifies persistent gaps in readiness. Only 54% of national health adaptation plans assess risks to health facilities. Fewer than 30% of health adaptation studies consider income, 20% consider gender, and less than 1% include people with disabilities. More than 60% of National Adaptation Plans have no formal tracking or evaluation in place. “Extreme heat, air pollution and infectious disease all hit the most vulnerable hardest: children, pregnant people, older adults, outdoor workers, and communities with the fewest resources,” Dangour said. “At COP30 and beyond, governments must act on the science – cut emissions, invest in adaptation, and put health at the heart of climate action. Lives, economies, and our future depend on the solutions we deliver now.” Image Credits: COP30, COP30. How Intimate Partner Violence Affects Children 14/11/2025 Disha Shetty Children’s health suffers in households where their mothers are abused. Noma Bolani has a clear memory of her abusive father stopping the car in the middle of the highway in Durban, South Africa and asking her mother to get out. She was just six years old, but Bolani followed her mother out of the car, and together they sought help from a passing motorist. Bolani is now 38, and has anxiety stemming from early childhood experiences related to growing up with an abusive father and witnessing her mother being at the receiving end of emotional and financial violence. Ayesha*, 34, from New Delhi, India, grew up watching her mother being subjected to physical, emotional and financial violence from her father. He would sometimes also resort to silent treatment that would last weeks, refuse to pay school fees for Ayesha and her sister and resort to physical violence using belts, shoes and, at times, utensils. Ayesha suffers from Polycystic Ovary Disease (PCOD) that affects the regularity of her periods and causes hormonal changes. Her doctor believes the stress she was subjected to as a child played a significant role in worsening her PCOD. Like Bolani, Ayesha also carries mental health scars from watching violence directed at her mother. When mothers are at the receiving end of violence, it can make their children physically ill, according to a growing body of research. Impact on children’s health Health data from 37 countries in sub-Saharan Africa found that children under the age of five whose mothers experienced intimate partner violence (IPV) were more likely to develop diarrhoeal disease and symptoms of acute respiratory infections, according to a study published in The Lancet last year. It called for tailored interventions to address childhood morbidity and mortality attributed to IPV in “priority countries” – Burkina Faso, Burundi, Chad, Comoros, Gabon, Liberia, Nigeria, Sierra Leone, South Africa, and Uganda. “The most important thing is actually the cumulative effect,” said Abel Dadi, lead author and a social epidemiologist at the Menzies School of Health Research at the Charles Darwin University in Australia. His study looked at exposure to three kinds of violence – physical, sexual and emotional. “When they come together, their effect increases,” he said. Dadi’s team also found a strong link between IPV and stunting in Burundi, and IPV and children being underweight in Burkina Faso, although the results were not consistent across all countries. What is not yet clear is the exact pathway of how IPV directed towards the mother affects a child’s physical health. A mother and newborn at a health center in the Patna district of Bihar, India. Babies’ health and well-being is deeply affected by their mother’s health. Pervasive violence The World Health Organization (WHO) recognizes that violence against women is a major public health issue. Globally, one third (27%) of women experience IPV in their lifetime, according to WHO figures. In sub-Saharan Africa, these rates are even higher, with 45·6% of women experiencing IPV in their lifetime. Young women aged 15 to 19 are the most affected by IPV. By the time they are 19 years old, almost a quarter of adolescent girls (24%) who have been in a relationship have already been physically, sexually, or psychologically abused by a partner, according to WHO data. However, while it is widely accepted that intimate partner violence affects a woman’s mental, physical and sexual health at risk, its impact on children has not received the same attention. But a child’s health and well-being are completely dependent on their mother during pregnancy, and heavily dependent in the early years, so a mother’s health and well-being directly affects her child’s health. The WHO, which developed a toolkit with UN Women to prevent violence against women in 2019, acknowledges that violence against women and against children often occurs in the same household. Psychiatrists like Bessel van der Kolk, who wrote ‘The Body Keeps the Score’, and Gabor Mate, author of ‘The Myth of Normal’, have also brought the lifelong impact of childhood trauma into the public domain, particularly of growing up with abusive parents. But IPV has long been seen as a criminal issue rather than a health issue. In India, for example, hospitals have only recently started to offer health workers training to see it as a public health problem. “I don’t think it is a well-understood field of work in terms of a response from the courts or from the state’s response to children’s rights,” said Julie Thekkudan, South Asia consultant at Equality Now, a global non-profit that advocates for women’s and girls’ rights. Each dot represents a different country in the region. There has been progress, with signs that IPV is reducing in some low- and middle-income countries due to progress in women’s empowerment. The reason women find it hard to leave abusive relationships, especially in the Global South, is that they have been socialized to tolerate violence, according to Thekkudan. In societies that favour sons and devalue daughters, girls are socialized into believing that their “purpose in life is to get married”, she explained. Staying in a marriage, even if it is abusive, and seen as part of “making sure that your family honor is maintained”, Thekkudan added. That, in addition to the fact that women don’t always have the financial ability to leave, makes it a harder choice. Dadi said that any intervention design on maternal health should consider intimate partner violence as well as the mental health of the mother. Currently, most of these kinds of interventions are concentrated in high-income countries, according to research. On average, countries that do better on gender equity indexes usually also experienc lower levels of violence against women, according to takeaways published in The Lancet. But a woman’s higher economic status can also make her vulnerable. One study from sub-Saharan Africa showed that women’s employment, especially if they were the sole earners or if they earned more than their male partner, was linked to a higher level of intimate partner violence. Any solution “has to be a multi-pronged, multi-level”, said Thekkudan. “I don’t think there is one solution that will change the entire system or the structure.” *Name changed to protect identity Image Credits: Photo by Alex Pasarelu on Unsplash, BMGF, World Bank. Brazil Wins Limited Backing for COP30 Climate-Health Plan, But Nations Commit No Finance 13/11/2025 Stefan Anderson Belém framework wins backing from two dozen nations, but health remains outside formal UN climate negotiations. Brazil launched a sweeping climate-health action plan on Thursday, named after the COP30 host city in the Amazon, winning initial endorsements from roughly two dozen countries for a voluntary framework calling on nations to strengthen disease surveillance, build climate-resilient infrastructure, and protect vulnerable populations from the health impacts of rising temperatures and extreme weather. The Belém Health Action Plan outlines 60 action items across surveillance systems, evidence-based policies, and health innovation to address the health risks facing 3.3 billion people globally affected by the climate crisis. “The climate crisis is one of the most significant health challenges of our time,” states the plan, developed by Brazil’s health ministry in consultation with the WHO. Countries that endorse the voluntary framework will report their progress through UN climate negotiations during the second Global Stocktake at COP33 in 2028. The World Health Organization calls climate change “the greatest single risk to humanity,” and the World Bank estimates it could cause up to 15.6 million deaths between 2026 and 2050, with health impacts costing $8.6 to $15.4 trillion by mid-century. Initial supporters include European Union states such as France and Spain, small island nations like Tuvalu, African countries from Congo to Zambia, and others including Canada, Japan, the United Kingdom and Malaysia. Brazil’s health minister Alexandre Padilha said the plan had received backing from more than 80 nations and institutions, though the vast majority comprises civil society organisations like the Global Climate and Health Alliance, global health actors including Medicines for Malaria Venture and Drugs for Neglected Diseases Initiative, and UN agencies such as UNFPA, UNICEF and UNITAID. “We expect to have more by the end of the day and the end of the COP,” Padilha said, adding the presidency would continue “trying to engage and mobilise” more countries. “There’s a very strong commitment from our government and ministers of health in this plan.” Delegates gather in the plenary hall of COP30 in Belem for the launch of the Brazil-WHO-led health-climate adaptation plan. The voluntary nature of the framework and broad support for the Alliance for Transformative Action on Climate and Health (ATACH) — a WHO-led initiative launched at COP26, which now counts 101 members — suggest endorsements will likely grow, but implementation remains uncertain. WHO will serve as the secretariat for the Belém plan, measuring outcomes through the ATACH framework. The sole explicit dissent Thursday came from Egypt, part of the Baku coalition of previous COP presidencies that helped draft the plan. Egypt’s health minister expressed willingness to join but voiced “concern about the reference to the inclusion of LGBTIQ+ individuals, as such patterns fall outside the nationally recognised policy frameworks in the cultural context of Egypt.” Other coalition members, the United Arab Emirates and Azerbaijan, expressed political will to continue discussions but stopped short of endorsement, instead noting they had “contributed” and “noted with interest” the framework’s goals. “We have to look at the impact of climate change, one of the main threats to public health in the world today,” Padilha said. “Scientific evidence has shown clearly that the climate crisis is first and foremost a crisis of public health throughout the world.” “The time of warnings has finished. Now we are living in a time of consequences,” he added. “The climate has already changed, so we have no alternative but to have public policies to adapt and face climate change.” No money from nations The voluntary adaptation framework was endorsed by around countries but faces billions in funding shortfalls. The launch came with no new financial commitments from endorsing nations. The sole funding announcement came from a coalition of philanthropies including the Gates Foundation, Wellcome Trust, and Rockefeller Foundation: a $300m one-time grant to support climate-health adaptation measures. That figure is dwarfed by estimates that low- and middle-income countries require at least $11 billion annually just for basic health adaptation covering only disease control for malaria, dengue, diarrheal diseases, heat-related mortality, and essential surveillance improvements, according to the UN Environment Programme. “Health systems, already stretched and underfunded, are struggling to cope with these growing pressures, and most are still unprepared for what is coming,” said Marina Romanello, executive director of the Lancet Countdown at University College London. “Existing finance falls short by billions. Without urgent investment, we will not be able to protect populations from escalating climate impacts.” The $11 billion annual UNEP pricetag excludes respiratory illnesses, malnutrition, mental health services, additional infectious disease programs, workers’ health protection, supply chain adaptation, and health system decarbonisation — most of what the Belém plan contains. The UNFCCC estimates global health adaptation will require $26.8 to 29.4 billion annually by 2050. Current health-specific climate finance reaching those countries totals perhaps $500 to $700 million annually, representing 2% of adaptation funding and 0.5% of multilateral climate finance. “With regards to finance, that reality is that we have a deficit that is quite colossal,” said Carlos Lopes, Special Envoy for Africa to the COP30 Presidency. A WHO survey of National Health Adaptation Plans found all included climate-health risks. But just 28 nations worldwide have completed such plans. As temperatures continue rising and extreme weather events intensify, pressure mounts for health system adaptation at a moment when global health financing faces unprecedented strain. Overall development assistance for health dropped 21% from nearly $50 billion in 2024 to $39 billion in 2025, driven largely by US withdrawal from global health programs. The WHO itself faces budget shortfalls of 15-20%. Climate-health financing has grown from less than $1 billion globally in 2018 to $7.1 billion in 2022, the only aid sector to grow in that time apart from education, according to Rockefeller Foundation analysis. But substantial portions arrive as loans: 24% of bilateral climate-health funding and more than 90% from the Asian Development Bank and Inter-American Development Bank. Many developing countries now spend more on servicing debt than on healthcare, with low-income countries spending roughly 300 times less per capita on health than wealthy nations. That finance shortfall impacts their ability to implement adaptation plans like the Belem Framework: A 2021 WHO survey found that while half of the countries reported having national health-climate strategies, less than a quarter achieved high implementation levels. Insufficient financing was identified as the key barrier by 70% of responding countries. Health’s struggles mirror wider climate adaptation finance gaps. At COP26 in 2021, developed countries pledged to triple overall adaptation finance from 2019 levels to at least $120 billion per year by 2025. Actual flows across all sectors totalled $26 billion in 2023. Money will determine whether Belém becomes an implemented plan or another symbolic declaration. Without tens of billions in annual funding, it will likely follow previous COP health commitments that failed to translate rhetoric into action. “The Belém Health Action Plan gives us the blueprint,” said Simon Stiell, executive secretary of the UN Framework Convention on Climate Change. “What we need now is sustained, coordinated and well-financed action to turn its promises into protection for all.” What’s the plan? Launch event for the Belem Health Action Plan at COP30. The Belém plan functions as a framework of best practice recommendations for adapting health systems to the climate crisis, containing no legally binding requirements or targets. Instead, the document outlines recommendations organized around surveillance systems, policy interventions, and infrastructure overhauls that officials say are essential to protecting billions from climate-driven health crises. The one specific requirement: Countries that endorse it will report progress through the Paris Agreement’s Global Stocktake by COP33 in 2028, with no enforcement mechanisms or compliance requirements. “For decades, WHO has been calling for action to adapt health systems and build resilience to climate change,” said Tedros Adhanom Ghebreyesus, WHO director-general. “The Belém health action plan is how we can do that.” “Health systems themselves are affected by climate change, compromising their ability to deliver life-saving care when people need it most,” he said. “There can be no healthy people on a sick planet.” The first focus: building the capacity to see threats coming. The framework calls for climate-informed health monitoring that links meteorological agencies with health institutions, using predictive modelling to trigger early warnings before heat waves, floods, or disease outbreaks overwhelm communities. Surveillance should also track which populations face the greatest risks, data officials say is often missing. The second area addresses policy interventions to protect communities, including clean energy and sustainable transport, heat protection for workers, mental health support woven into climate response, and targeted measures for Indigenous peoples and persons with disabilities. ”For many countries, adaptation is a question of survival in the short run. If you don’t adapt, it threatens the coverage of health services of patients and professionals who are already facing adverse conditions,” Padhila said. “If we don’t adapt, we are going to increase inequality. In short, if you don’t adapt, we will kill people.” Water & power “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. Finance will determine whether the Belém framework’s most ambitious element, climate-resilient infrastructure, can be delivered. The plan envisions health facilities built to withstand climate shocks, renewable energy powering clinics, telehealth platforms extending care, and strategic stockpiles of temperature-stable medicines and vaccines. It calls for “integrated methodologies linking environmental, meteorological, social, climate and health monitoring data” with real-time surveillance and digital technologies as “structural components.” The problem: roughly 100,000 health facilities in sub-Saharan Africa lack reliable electricity, affecting nearly a billion people worldwide. Up to 70% of medical equipment in developing countries sits unused due to power failures. Cold chains for vaccines, digital surveillance systems, early warning platforms, and telehealth services all depend on reliable power that serving populations don’t have. Closing the healthcare electrification gap by 2030 would cost $4.9 billion, about $5 per person affected over six years. That’s less than one year of current global climate-health spending. “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. “It is very important we have the policies… working on the value chains of electricity to make sure that our babies, who are getting born without electricity,” have access to care. Water and sanitation infrastructure are equally critical, she noted. “If we bring water, we bring sanitation. There is already a disease that we will put away. We can tell our boys and girls to wash their hands, but how could they do it if there is no water at the school?” Just three nations have completed all four ATACH assessments as of 2025. The Belém plan’s success will depend not just on building infrastructure, but on countries’ ability to track and report progress. WHO will measure implementation through ATACH, its Alliance for Transformative Action on Climate and Health, which already requires members to complete vulnerability studies, adaptation plans, emissions inventories, and decarbonization roadmaps. The record so far suggests those demands exceed many countries’ capacity. Four years after ATACH’s launch in 2021, only three countries—France, Japan, and the UK—have completed all four assessments. Across 88 countries with available data, roughly 35-40% completed vulnerability assessments and 30% finished adaptation plans. In Africa, fewer than 10 of 29 ATACH members have completed vulnerability assessments. The Belém plan now adds reporting requirements on top of those existing gaps: tracking mental health impacts, monitoring workers’ heat exposure, establishing community resilience programmes, and climate-proofing supply chains, all by 2028. That creates an impossible bind. France, Japan, and the UK have the technical capacity and resources to meet these demands. Many other countries lack not only the expertise for complex reporting systems, but the basic infrastructure, electricity and water, that the plan assumes as a foundation. “Finance is still the bottleneck for us,” Princess Djigma said. Fossil fuel phase-out excluded Delegates arrive for the opening day of COP30 on the edge of the Brazilian Amazon. Notably absent from the plan is any reference to phasing out fossil fuels, the main driver of climate change and the resulting heat, extreme weather and air pollution killing approximately 8m people annually from respiratory and cardiovascular diseases. The omission came at the explicit instruction of the Brazilian COP30 presidency, according to people familiar with the negotiations. The exclusion comes as the International Energy Agency warned Wednesday that global oil and gas demand will rise for the next 25 years if countries do not change course. Until this year, all of the Paris-based body’s modelling assumed fossil fuel consumption would peak this decade. “Climate change is declining — and declining rapidly — in the international energy policy agenda,” said Fatih Birol, the IEA’s executive director. “And this is happening while 2024 was the hottest year in history.” Fifteen countries allocated more resources to fossil fuel net subsidies than their entire national health budgets. Birol’s findings align with the Lancet Countdown report published ahead of the summit, which found the 100 largest oil and gas companies have production strategies that put them on track to exceed their share of production consistent with 1.5 °C of heating by 189% in 2040, up from 183% in March 2024. Private bank lending to fossil fuel activities surged 29% to $611 billion in 2024, exceeding green sector lending by 15%. Some 73 of 87 countries reviewed provided net explicit fossil fuel subsidies in 2023, allocating nearly $1 trillion in direct support. Including indirect subsidies, that figure rises to over $7tn, according to the International Monetary Fund — more than governments spend annually on education and about two-thirds of what they spend on healthcare. The declining political attention extends to international engagement: Mentions of health and climate change by governments in their annual UN General Assembly statements declined from 62% in 2021 to 30% in 2024, according to the Lancet Countdown. “Record deaths from climate-driven wildfires in 2023 show that there’s no adaptation without mitigation,” said Nina Renshaw, head of health at the Clean Air Fund. “Ministries of Health and Finance won’t be able to bail hospitals and clinics out of the climate emergency if governments don’t stop the emissions which are already causing unprecedented harm.” ‘More than dialogue’ Delegates convened for the first-ever Health Day at a UN climate summit in Dubai. The Belém plan follows a pattern established at recent climate summits: the COP28 Dubai Health Declaration signed by 143 countries, the Baku Coalition for Climate and Health launched last year, and efforts stretching back to Glasgow in 2021. Like those efforts, Belém is a non-binding, voluntary process taking place outside formal UN negotiations. Criticisms of the outcomes of Dubai and Baku describe their outcomes as symbolic gestures that generate attention but fail to secure funding, sustained commitment, or implementation. Officials on Thursday repeatedly stressed the need to break the holding pattern. “This gathering must be more than dialogue,” said Jarbas Barbosa, director of the Pan American Health Organization. “It must galvanise collective action and inspire new policies dedicated to protecting everyone’s health from the worsening effects of climate change.” “The climatic crisis is fundamentally a health crisis,” Barbosa said. “We are not talking any more about distant or possible threats. Climate change is a present and growing reality.” Whether the Belém framework can overcome the obstacles that have stymied previous declarations — insufficient financing, limited technical capacity, competing priorities — remains uncertain. But Padilha argued the world has no choice but to try. “We are faced with a dilemma: we either continue to speak and speak and talk, or we can walk the walk and make the political commitment to do so,” he said. “We cannot accept the erosion of multilateralism in global health. Those who deny multilateralism are surrounding us. We will not listen to them.” Image Credits: COP30, COP30, COP30, COP30, COP30, COP30, WHO . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Global Fund Raises $11.4 Billion, Including $4.6 Billion From United States 21/11/2025 Kerry Cullinan The opening of the Global Fund’s Eighth Replenishment Summit, co-hosted by South Africa and the United Kingdom, a high-level, hybrid side event convened on the margins of the G20 Leaders’ Summit. Johannesburg, South Africa, on Friday 21 November, 2025. JOHANNESBURG – The United States pledged $4.6 billion to the Global Fund during its eighth Replenishment Summit in Johannesburg on Friday – a reduction from its previous pledge of $6 billion, but also an indication that it has not abandoned all multilateral global health efforts. The Global Fund has now raised $11,4 billion of its $18 billion target for the next three years – but several key countries and groups, including France, Japan and the European Commission, have yet to pledge. South African President Cyril Ramaphosa, who co-hosted the Replenishment, said that it was a milestone at a time when multilateralism is being “sorely tested”. “Building resilient health systems, scaling up local manufacturing of medicines, diagnostics and therapeutics and securing sustainable financing are vital for the social and economic development of the people of the world who are vulnerable,” said Ramaphosa. “Without a healthy population, nations cannot prosper. It is therefore essential that we close gaps in access to medicines, diagnostics and therapeutics and financing so that every country can protect its people and achieve health equity.” South African President and Replenishment co-host Cyril Ramaphosa United Kingdom Prime Minister Keir Starmer, the other co-host, said this was the first Replenishment to be hosted by countries in the Global North and South. “Since the UK hosted the first Replenishment back in 2002, our shared investments have saved over 70 million lives across more than 100 countries, cutting the combined death rate of these diseases by almost two-thirds,” said Starmer. “Heartbreaking, malaria still kills a child under five years of age every minute, 4,000 adolescent girls and young women still contract HIV every week. TB remains the world’s single deadliest infectious disease, even though we’ve had a cure for almost a century, and the rise of antimicrobial resistance threatens some of the progress that we thought we’d managed,” he added. Starmer praised the growing investment of the private sector in the Global Fund, and the reforms in the development sector enabling countries to drive their own programmes more successfully. UK Prime Minister and Replenishment co-host Keir Starmer Announcing the US pledge via video, Jeremy Lewin, US Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, described the Global Fund as a “critical partner” in advancing his country’s new ‘American First’ strategy. The US had undergone a “rigorous review” of its multilateral commitments, and “left numerous multilateral organisations, including the WHO and Unesco, as they do not work for the American people,” Lewin noted. However, while the Trump administration views “foreign assistance as a tool of US diplomacy” and every taxpayer’s dollar is being assessed in terms of “America First”, the US is “proud of its legacy as the most generous nation in the world”, he added. “The best days of American healthcare leadership are yet ahead. The State Department recently unveiled our new ‘American First’ global health policy, which affirms our commitment to global health but enacts much-needed reforms. “The Global Fund is a critical partner in advancing our America First strategy. It has long advanced the key tenets of our approach, investing much of its resources in scaled procurement of health commodities,” said Lewin. “Under the leadership of [executive director] Peter Sands, we have every confidence that its legacy of excellence will continue,” he concluded. The US pledge is tied to a 1:2 commitment, meaning that every $1 from the US has to be matched by at least $2 from other donors. Last month, Germany announced a €1 billion pledge at the World Health Summit in Berlin (down from €1.4 billion previously). Other substantial donors include Canada, which committed CAD$1.02 billion, the Netherlands, committing €195.2 million; Norway, which committed $200 million; Italy giving €150 million; Ireland increasing its commitment to €72 million, and the Gates Foundation, which pledged $912 million. Image Credits: Global Fund. South Africa May Be Excluded From Future US Grants for HIV Amid Political Row 21/11/2025 Kerry Cullinan South Africa may be excluded from future PEPFAR grants as its relations with the US deteriorate. The United States (US) government has not sought a meeting with South Africa to discuss the resumption of its HIV grant, and it won’t supply the country with the long-acting HIV prevention medication, lenacapavir, amid a deepening political row between the two countries. While US Ambassadors throughout the continent have initiated meetings with African Health Ministers to discuss Memorandums of Understanding (MOU) to set out new terms for the continuation of their US President’s Emergency Plan for AIDS Relief (PEPFAR) grants from April 2026, South Africa has not received such an invitation. “The Department of Health has not received any correspondence from the US government regarding PEPFAR discussions,” Foster Mohale, South Africa’s Health Ministry spokesperson, told Health Policy Watch. A US State Department spokesperson told Health Policy Watch that the US government “is still deliberating future health assistance to South Africa pending broader bilateral discussions”. “The State Department approved the PEPFAR Bridge Plan for South Africa for a six-month implementation period, spanning from 1 October 2025, to 31 March, 2026. The $115 million allocated under this plan supports core life-saving HIV services,” according to the US State Department spokesperson. “The Bridge Plan prioritises service continuity with minimal programmatic changes, focusing on country-specific needs and maximising life-saving impact.” In relation to whether the US would provide lenacapavir to South Africa, a US Embassy spokesperson provided a comment by Jeremy Lewin, Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, stating that the US “will not be contributing doses to South Africa”. “Obviously, we encourage every country, especially countries like South Africa, that have significant means of their own to fund doses for their own population of this innovative American-made drug that Gilead has developed. US-funded doses will not be going to South Africa,” Lewin told a media briefing on 17 November, the day the first 1,000 lenacapavir doses were delivered in Eswatini and Zambia. The US will provide lenacapavir to Eswatini, Kenya, Lesotho, Malawi, Mozambique, Philippines, Uganda, Ukraine, Zambia, and Zimbabwe. Largest HIV+ population A patient getting an HIV test at Witkoppen Clinic, which received PEPFAR for HIV-related services. Around eight million South Africans are living with HIV, around 13% of the population – the largest HIV positive community in the world. In 2024, South Africa received $453 million in PEPFAR funding, and $439 million had been allocated for 2025. But this was suspended when Donald Trump became president on 20 January. In October, the US government approved a $115 million “PEPFAR Bridge Plan” for South Africa for six months from 1 October to 31 March 2026. Relations between the US and South Africa have been rocky since Trump took office, signing an executive order in February to “halt foreign aid or assistance delivered or provided to South Africa”. The order incorrectly claims that South Africa is persecuting white Afrikaners, and has “taken aggressive positions towards the United States and its allies, including accusing Israel, not Hamas, of genocide in the International Court of Justice”. The US has offered white Afrikaners refuge in the US, and Trump has made several disparaging remarks about the country, including at a meeting at the White House with South African President Cyril Ramaphosa. Earlier this month, the US pulled out of the G20 meeting being hosted in South Africa this weekend, with Trump repeating incorrect claims of discrimination against whites as the reason. All 2026 lenacapvir stock bought Lenacapavir, packaged as Sunlenca in the US, where is sells for $42,250 for two injections. The US government and the Global Fund have bought all of Gilead’s 2026 stock of lenacapavir, a twice-a-year injectable that is almost 100% successful in preventing HIV transmission. The Global Fund’s HIV head, Izukanji Sikazwe, told Health Policy Watch that her organisation will supply South Africa and all countries in need with lenacapavir “based on evidence of need”. But eight patient advocacy groups described the rollout of 500 lenacapavir doses each for Eswatini and Zambia as a “public relations stunt” in a media release on Thursday. “Africa and the Global South are being offered merely symbolic handouts, while Gilead and donors shape markets to serve corporate and geopolitical interests, not urgent public health needs,” said Fatima Hassan, director of the Health Justice Initiative (HJI). “By procuring a minuscule number of doses, Gilead can claim that [lenacapavir] is ‘introduced’ in Africa, creating demand and laying the path for commercial bullying instead of introducing the product at actual cost and at scale. This is a profit-seeking, corporate strategy dressed up as solidarity,” she added. Gilead announced in October 2024 that it has authorised six generic manufacturers to sell lenacapavir in 120 low- and middle-income countries, although none are from sub-Saharan Africa. It also excluded several Latin American countries including Brazil and Colombia. The medicine is licensed in the US as Sunlenca for people with drug-resistant HIV, and currently costs $42,250 a year for two injections. The generics are only likely to be available in 2027 at the earliest, and the advocacy groups claim Gilead is “frustrating the speed at which generic entries are possible”, as it has not yet filed an application with India’s drug regulatory authority and has prioritised registration in only 22 countries. ‘Insulting’ The advocacy groups estimate that at least 10 million Africans need lenacapavir to achieve the global goal of a 90% reduction in new HIV infections by 2030, with two million of these being South Africans. However, the US will only provide doses for 325,000 people in 2026 – an “insulting” amount in comparison to the need, said Bellinda Thibela, Health GAP’s International Policy and Advocacy coordinator. “Instead of crumbs, the US should be providing millions of lenacapavir doses, to alter the course of the HIV pandemic and to repair the harms caused by their illegal and deadly cuts to HIV programmes since January,” added Thibela. However, Brad Smith, US Senior Advisor for the Bureau of Global Health Security and Diplomacy, told a media briefing this week that Gilead’s available volume in 2026 is 600,000 doses, but that the US and the Global Fund are committed to buying two million doses. “We anticipate a continued increase in demand and production capability over time to enable us to meet the two million doses sometime in mid-2027,” said Smith, adding that the doses were being split 50/50 between the US and the Global Fund. “We are working out between ourselves exactly who will distribute and procure for which country,” Smith added. Speaking at the same media briefing, Gilead CEO Daniel O’Day said his company was able to “provide Lenacapavir at no profit to Gilead to the countries with the highest burden of HIV”. US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Political decisions Citing the US Executive Order against South Africa, the advocacy groups say that the US has made the country “the target of harsh foreign policy decisions based on the Trump administration’s racism, lies, and conspiracy theories”. Nigeria is also being “pushed out” of lenacapavir support “after being criticised by US government officials, including for refusing to imprison US detainees extracted during US immigration raids”, they claim. “In contrast, Eswatini has accepted the offer of not just the 500 lenacapavir doses ahead of World AIDS Day, but also $5.1 million in funding from the US government in exchange for imprisoning US detainees,” they note. Sibongile Tshabalala, Chairperson of the Treatment Action Campaign (TAC), called for either Gilead to license South African generic companies to make lenacapavir, or for the South African government to “use its lawful powers to issue compulsory licenses”. “Now that the Trump administration has openly tied the global rollout of lenacapavir to a political standoff rewarding ‘compliance’ but punishing African political autonomy and sovereignty, South Africa must step forward with principled global leadership,” the groups add. This story has been updated to include the US State Department’s comment. Image Credits: The Global Fund/ Saiba Sehmi, International AIDS Society, Witkoppen Clinic, Gilead. Global Fund Seeks $14 Billion at Replenishment Summit – With Progress Against HIV, TB and Malaria at Risk 20/11/2025 Kerry Cullinan Deborah and her 10-month-old daughter Catherine at the Baylor College of Medicine Children’s Foundation in Lilongwe, Malawi. Deborah is living with HIV and Catherine is on preventive treatment. JOHANNESBURG – The Global Fund (GF) has only raised $4 billion of its $18 billion budget for the next three years – so much is riding on its Replenishment Summit in Johannesburg on Friday (21 November) as it seeks the balance to advance progress against HIV, tuberculosis (TB) and malaria. The United States has been the largest donor to the Global Fund, contributing around one-third of its budget – but whether it will still contribute generously is an open question, given the Trump administration’s “America First” focus. “We have been in almost constant dialogue with the US since the beginning of the year, and we have not received any stop-work order or any sort of notification that the funding will be stopped,” Francoise Vanni, the Fund’s external relations and communications director, told a media briefing in Johannesburg on Thursday. “We are confident that they will pledge to the Replenishment tomorrow,” added Vanni, pointing out that the US and the GF are working closely to roll out the long-acting HIV prevention medicine, lenacapavir, in several African countries. South Africa and the United Kingdom (UK) are co-hosting the Replenishment, but that did not prevent the UK from cutting its contribution by 15%. The Fund provides 73% of all international financing for TB, 60% for malaria and 24% for HIV. Médecins Sans Frontières (MSF) has described initial pledges as “deeply concerning”. “Germany and the United Kingdom – the only major traditional donors to pledge so far – have both decreased their commitments compared to the last cycle. Specifically, Germany has pledged €1 billion instead of €1.3 billion and the UK has pledged £850 million instead of £1 billion,” MSF noted on Thursday. “No donor has increased their pledge when considering inflation. If other major donors follow Germany and the UK’s examples, the results would be catastrophic for people impacted by TB, HIV, and malaria worldwide,” MSF said. “Failure to meet this [$14 billion] goal would risk catastrophic cuts to essential services, threaten the resurgence of HIV, TB, and malaria – the world’s top three deadliest infectious diseases – and put the financial burden of health care onto the world’s most vulnerable patients.” Members of a spray team prepare their equipment before spraying homes with insecticide to protect families from malaria in Kaukira, Honduras. Saving 70 million lives The GF is the world’s largest funder of global health, and it has saved an estimated 70 million lives since its establishment 22 years ago, according to its Results Report 2025. Around $103 billion has also been saved in reduced hospitalisations, freeing countries’ health systems to address other diseases and other health needs, Vanni noted. While it works in over 100 countries, its effect has been felt primarily in Africa, where 73% of its budget has been spent. In 15 priority countries in sub-Saharan Africa, life expectancy has increased from 49 years old in 2001 to 61 in 2021 – mostly thanks to people with HIV getting access to antiretroviral medicine. In Zambia, for example, life expectancy has increased by 19 years from 43 to 58 years. Since the GF was launched in 2002, AIDS-related deaths have been reduced by almost three-quarters in the countries where the Global Fund operates, and new infections have been reduced by 62%. Without these interventions, AIDS deaths would have increased by 90% and new HIV infections by 75% over the same period. In 2024 alone, Fund-supported TB programmes treated 7.4 million people with TB. Between 2002 and 2023, GF efforts have reduced TB deaths by 40%. Without these, TB deaths would have increased by 134% and TB cases by 40% over the same period. Malaria deaths were reduced by 29% between 2002 and 2023, “even though the population in these countries has increased by 46%”, the Results Report notes. “Without malaria control measures, deaths would have increased by 94% over the same period.” Malaria ‘way off target’ Despite progress, HIV, TB and malaria remain the world’s deadliest infectious diseases. The $18 billion budget could save 23 million lives between 2027 and 2029, avert 400 million new infections and result in a 1:19 return on investment across the three diseases, according to Fund modelling. “Malaria is way off track, with 600,000 people a year dying,” admits Kate Kolaczinski, the Fund’s senior specialist on the disease. “Malaria is the leading cause of outpatient visits in sub-Saharan Africa,” she adds, with 263 million malaria cases in 2023. Between 2002 and 2023, malaria cases in countries supported by the Global Fund increased by 8% “Rising conflict, disruptions from extreme weather events and increasing resistance to antimalarial drugs and insecticides have complicated efforts to combat malaria in 2024,” according to the Results Report 2025. “The goal of ending [malaria] by 2030 looks daunting. Reductions in global health funding could undermine progress against malaria. A widening funding gap, combined with existing crises and an expected population growth in areas at high-risk of malaria, could threaten the lives of millions.” President Duma Boko of Botswana has urged countries to support the Replenishment, noting in an exclusive article for Health Policy Watch: “If the world retreats now, an additional 750,000 children in Africa could die by 2030, and our economies could lose $83 billion in GDP if funding is so low that all prevention interventions are halted.” HIV resurgence? “There’s a risk of HIV resurgence, especially now that we have funding challenges that we’re facing,” says the Fund’s HIV head, Izukanji Sikazwe, pointing out that 9.2 million people living with HIV still need access to treatment. “We are off target for HIV prevention. In 2024, there were 1.3 million new infections. We need a fourfold reduction to meet the 2025 target of 370,000.” Meanwhile, TB surged during the COVID-19 pandemic and but 2024 brought new progress against the disease. “Robust funding commitments in 2025 are absolutely critical to maintaining our momentum against TB and preventing a resurgence that could undo decades of hard-won progress,” according to the Results Report 2025. It describes an “exciting pipeline of innovative tools”, including new TB tests, better treatments and “at least five TB vaccines in phase III efficacy trials”. Private sector contributions While the bulk of the Fund’s budget comes from country contributions, the private sector also contributes – with the Gates Foundation being the biggest and most consistent private donor, contributing $3.91 billion since 2002. “The Global Fund will go down in history as one of humanity’s biggest achievements. It’s also one of the kindest things people have ever done for each other,” according to Gates Foundation chair Bill Gates. The Global Fund’s track record proves it is an excellent investment for our global health dollars. Its work is critical to achieving the goal of ending AIDS, TB and malaria, and making our world a more equitable place for people everywhere.” The Children’s Investment Fund Foundation (CIFF) has significantly increased its contribution recently, focusing on expanding access to lenacapavir by both supporting procurement and the development of generics. John Fairhurst, who heads the Fund’s private sector mobilisation, says that the sector has contributed over $5.3 billion in the past 20 years – often playing a “catalytic role” in innovation. Unlike countries, which give unrestricted funds, private donors can earmark their contributions. Image Credits: Tommy Trenchard/ Global Fund, Global Fund. World Falls Far Short of Methane Cut Targets Halfway to 2030 Deadline 18/11/2025 Stefan Anderson Infrared camera reveals escaped methane emissions from oil rig. Methane leaks from oil and gas make a major contribution to global warming. First UN assessment since the 2021 Glasgow pledge shows methane cuts falling far short of targets needed to meet climate goals. Accelerated action could yield $330 billion in annual benefits by 2030 through improved health and reduced crop losses. Four years after more than 100 countries pledged to slash methane emissions 30% by the end of the decade, a UN assessment has found nations are on track to deliver barely a quarter of that target. The Global Methane Status Report, released Monday at COP30 in the Brazilian Amazon city of Belém, found that current national commitments would cut global methane emissions by just 8% below 2020 levels by 2030. Despite the lack of progress, the 30% target remains technically achievable with increased investment and policy-driven reform, the report found, adding it could yield some $330 billion in benefits to health and cost production, nearly double the cost of investment in methane emissions mitigation. While methane emissions are not a part of formal negotiations in the UN Framework Convention on Climate Change (UNFCC)C, it is the world’s second largest contributor to global warming, after CO2, with a global warming potential 86 times greater. A precursor to ground-level ozone formation, methane is a contributor to air pollution-related deaths as well as reduced crop yields. With an atmospheric lifespan of only about 12 years, reducing methane emissions can yield enormous co-benefits for health as well as reducing the pace of climate change. Collective, non-binding target The Global Methane Status Report produced by the UN Environment Programme is the first comprehensive stocktake of global progress on methane emissions since reduction targets were announced at COP26. The assessment comes as global methane concentrations have reached the highest levels in at least 800,000 years, more than 2.6 times pre-industrial levels, with the gas responsible for roughly one-third of present-day global warming. The new report compiled by the UN Environment Programme is the first comprehensive stocktake since the Global Methane Pledge was launched at the UN climate summit in Glasgow, COP26. The Global Methane Pledge, a non-binding political commitment signed by 159 countries, set a collective global reduction target rather than assigning specific cuts to individual countries or sectors, leaving nations to develop their own strategies and action plans. “Slow climate action means that the multi-decade average of global temperatures will exceed 1.5°C within the next decade,” Ruth do Cutto, deputy climate change chief at UNEP said at a press briefing launching the report. “We must make sure that this overshoot is as short and as low in temperature as possible, and we cannot do that without curbing emissions of methane, which is responsible for one-third of today’s global warming.” Methane’s potency as a greenhouse gas, combined with its relatively short atmospheric lifespan, makes cutting emissions one of the fastest ways to slow near-term temperature rise, often called an environmental “hand brake” by climate experts. “Lack of time is our biggest challenge,” said COP30 President Ana Toni, noting that slashing methane emissions “delivers the fastest results” for slowing warming. Full deployment of what the report calls “maximum technically feasible reductions” could still cut emissions 32% below 2020 levels by 2030, even surpassing the pledge target. These measures would cost an estimated $127 billion annually but deliver benefits valued at $330 billion per year by 2030, including preventing more than 180,000 premature deaths, avoiding 19 million tonnes of crop losses, and reducing global temperatures by 0.2°C by mid-century. “We’re on a highway to hell with the foot on the gas pedal,” Martina Otto, head of the Climate and Clean Air Coalition Secretariat, which produced the report with the UN Environment Programme, said at the launch event in Belém. “If we are heading towards the wall, you don’t just pull the handbrake a little bit. You pull it forcefully and fast. And I think that’s where we are right now,” Otto said. Slow momentum, US wildcard The 159 countries now signed to the pledge, up from just over 100 at launch, represent nearly half of global methane emissions. However, three of the world’s top five emitters remain outside the agreement: China, the largest overall source, India and Russia. China’s participation in a methane summit co-hosted with Brazil and the United Kingdom on the sidelines of COP30 marked a notable diplomatic shift, though Beijing has yet to sign the global methane pledge. Since the pledge’s launch, projected 2030 emissions have improved modestly. Some 127 countries, representing 65% of Paris Agreement parties, now include methane mitigation measures in their latest Nationally Determined Contributions, a 38% increase from pre-2020 levels. New waste management regulations in Europe and North America, combined with slower-than-expected growth in natural gas markets between 2020 and 2024, have lowered forecast emission levels by 14 million tonnes compared with 2021 projections, UNEP found. The emissions decrease documented in the report is relative to levels projected in 2021, not a net reduction. While methane emissions were on track to increase by 13% by 2030, that would fall to 5% if nations follow through on pledged cuts. Overall, global methane emissions continue to rise, reaching approximately 352 million tonnes in 2020 and projected to hit 369 million tonnes by 2030 under current legislation. “If countries fully implement their existing methane plans submitted as of June 2025, global emissions could fall by about 8% this decade,” Otto said. “That would constitute the largest and most sustained decline in methane emissions ever recorded. So it works, but it doesn’t work fast enough.” The report’s modelling does not account for the United States reversing its methane commitments. While the US was once a leading nation in advocating methane emissions cuts and a core author of the 2021 pledge in Glasgow, the Trump administration has rolled back domestic methane policies and pressured the European Union to delay implementation of new methane emissions regulations that would increase reporting transparency. Some US states, including California, have maintained stricter methane reporting requirements. Agriculture, energy and waste lead methane-emitting sectors Global anthropogenic methane emissions in the current policies scenario, 1990–2050, million tonnes per year The UNEP report found that agriculture accounts for 42% of global methane emissions, the energy sector 38%, and waste 20%. The G20 countries plus the European Union and several other developed nations are responsible for 65% of total emissions, with China taking the top spot. The energy sector offers the largest mitigation opportunity, UNEP said, with 72% of technically feasible reductions by 2030 concentrated in oil, gas and coal operations. More than 80% of the total reduction potential across all sectors can be achieved at costs below $36 per tonne of CO2 equivalent, with many fossil fuel measures actually profitable because they capture gas that can be sold rather than vented or flared. Inger Andersen, executive director of UNEP, said “reducing methane emissions is one of the most immediate and effective steps we can take to slow the climate crisis while protecting human health.” Chloe Brimicombe, a climate scientist at the Royal Meteorological Society, linked methane emissions to more frequent and intense heatwaves, which kill nearly 600,000 people annually. “Heat puts immense stress on the body, particularly for children, older people and those with chronic illness,” she said, describing methane cuts as a “fast and effective way to help protect communities from heat-related illness and deaths.” “Reducing methane decreases the precursors of ground-level ozone, reducing cardiovascular and respiratory disease immediately,” said Courtney Howard, an emergency physician and chair of the Global Climate and Health Alliance. “Cutting methane is a win-win for health and health systems now and into the future.” ‘On the radar’ Global anthropogenic methane emissions under different scenarios, 1990–2050, million tonnes per year. Regional studies “continue to reveal significant underreporting of methane emissions, particularly within the fossil fuel sector,” the report found. Dan Jørgensen, European Commissioner for Energy and Housing, said nearly 90% of satellite-detected emission events still go unaddressed by governments and fossil-fuel companies. Liz Thompson, climate ambassador of Barbados, called reining in these oversights a “matter of survival” for small island nations. “We need oil and gas companies to recognise the importance of cutting methane emissions by stopping flaring and leaks,” she said. “Over the next year, we must advance discussions so that COP31 can perhaps present a concrete proposal to initiate efforts that will lead to a legally binding agreement.” Current methane-focused investment has reached $13.7 billion annually, up 18% in recent years but far below the $127 billion needed by 2030. Measures in the fossil fuel sector could be deployed at little to no net cost, with bills for the energy sector overall representing just 2 to 4% of the industry’s 2023 income, according to the report. “It shows that methane has made it onto the radar and that we’ve gained momentum, that cost-effective solutions exist today, essentially waiting to be brought to scale, and that the benefits are enormous,” Otto said. “We can do it, but we have to act much faster.” China’s participation in COP30 methane summit marks a shift The report launch coincided with a “methane summit’’ co-hosted by Brazil, China and the United Kingdom on the sidelines of COP30. The summit launched a “Super Pollutant Country Action Accelerator” providing $25 million in initial funding for seven developing countries to establish dedicated national methane units, modelled on the successful Montreal Protocol ozone programmes. China’s participation marked a significant diplomatic development, as Beijing co-hosted the event despite not being a signatory to the Global Methane Pledge. The country is the world’s largest methane emitter, primarily from its massive coal mining sector. “The summit not only underscores the critical role of controlling methane and other non-CO2 greenhouse gas emissions in the global response to climate change, but also encourages all parties to share the policies and actions they have taken in the emission reduction process,” Huang Runqiu, China’s environment chief, said at the summit. “Climate change is a global challenge, and addressing it requires concerted efforts from the entire world.” The UK also led a statement signed by Canada, France, Germany, Japan, Kazakhstan and Norway committing to drastically reduce methane emissions in the fossil fuel sector, including ending routine flaring and venting by 2030 and developing a “near-zero methane intensity marketplace” by 2026 to use trade measures to reward low-emission producers. “The global methane pledge has had an impact. It supported the reshaping of national priorities,” Otto said. However, she noted the report had to exclude the latest round of national climate plans submitted after June 2025 from its modelling. “Obviously, we have seen new coming in, but we had to do the modelling at one point, and so that became our cut-off.” Beyond 2030, the report warned that technical fixes alone will prove insufficient. Meeting 1.5C or 2C warming targets will require combining methane controls with broader energy decarbonisation and demand-side measures, including dietary shifts and reduced food waste, potentially cutting emissions 53% below 2020 levels by 2050. “We can still make it,” Otto said. “But it will take a whole lot of additional effort. It’s not possible if we do it half-heartedly.” With five years remaining until the 2030 target, “the choices made in the next five years will determine whether the world seizes this opportunity, unlocking cleaner air, stronger economies, and a safer climate for generations to come,” UNEP concluded. Image Credits: Clean Air Task Force . Former DOGE Official Driving US Bilateral Health Agreements With African Countries 17/11/2025 Kerry Cullinan US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenyan Treasury and health officials. The United States government is moving rapidly to secure Memorandums of Understanding (MOU) with African countries that offer limited health aid for five years in exchange for 25 years’ access to countries’ data about “pathogens with epidemic potential”. Some commentators have described the terms of the bilateral MOUs as “extractive” as they fail to offer African countries access to the health products that might be developed from the pathogen material that they share. The process is being driven by Brad Smith, formerly one of the leaders of Elon Musk’s Department of Government Efficiency (DOGE), who was responsible for implementing deep cuts to the US Health and Human Services (HHS) department. Smith is now a global health advisor in the US State Department, overseeing the reorganisation of the US President’s Emergency Plan for AIDS Relief (PEPFAR) and health grants from the now defunct US Agency for International Development (USAID). He was part of the US delegation that met Kenyan health and finance officials last week to discuss its MOU. So too was Bethany Kozma, a former USAID official during the first Trump administration and a fervent anti-abortion campaigner. She is currently chief advisor for policy and strategy in the HHS Global Affairs Office. Bethany Kozma, anti-abortion campaigner and chief advisor for policy and strategy in the HHS Global Affairs Office, also attended the meeting with Kenya. Dr Chris Kiptoo, Kenyan Treasury’s Principal Secretary, reported after last week’s meeting that “both countries are finalising a bilateral agreement that aligns Kenya’s health priorities with the United States’ global health objectives, strengthening a partnership that saves lives and builds a more resilient health system for our nation”. Meanwhile, Rwandan Health Minister Dr Sabin Nsanzimana met a US delegation headed by Dr Mamadi Yilla, US State Department deputy assistant secretary for health diplomacy, last week to discuss a new MOU. Rwandan Health Minister Dr Sabin Nsanzimana and Dr Mamadi Yilla, US deputy assistant secretary for global health diplomacy and other officials. Smith also led the US delegation to Zambia on Monday (17 November), where he met Zambia’s Health Minister, Dr Elijah Muchima, and Finance Minister Situmbeko Musokotwane. The meeting aimed to “chart a new course for US health assistance to Zambia”, according to the US Embassy in Zambia. “The new approach envisions both governments committing to funding levels and health outcome performance objectives in order to accelerate the transition from an aid-dependent health sector to a Zambian government-led health system that is able to sustainably meet the health needs of the Zambian people,” according to the US media release. US official Brad Smith and Zambian Finance Minister Situmbeko Musokotwane. Extensive access to data The MOUs include clauses that would give the US extensive access to country health databases and contain punitive measures for countries that fail to provide this access or pathogen information, including unspecified “changes in the planned assistance” or total discontinuation of aid. Conversely, those that meet targets may get unspecified rewards. While the agreements contain a list of targets (“outcome metrics) for reducing HIV, TB, malaria, maternal and under-five mortality, and increasing measles vaccinations, details about how these will be achieved are scanty. In contrast to the health services section, the “surveillance and outbreak response” section is far more detailed, with budget allocations and staff numbers. For instance, Zambia is expected to employ “1,723 field epidemiologists” in 2026 at its own expense to meet its outbreak surveillance and pathogen-sharing requirements, according to a draft seen by Health Policy Watch. The US also notes in the draft Zambian MOU that it is making a $50 million cut to its previous commitment of $120 million in funding for antiretroviral (ARV) medicine and HIV tests due to “historic theft”. This relates to a 2021 scandal where it emerged that ARVs donated to Zambia were being sold in pharmacies. Countries need the capacity to detect disease outbreaks within seven days and report to the US on these within a day of an outbreak being detected, according to the MOUs. Twenty-five years’ access for five-year grants Countries also have to commit to signing a 25-year “specimen sharing agreement”, although the MOUs only cover a five-year grant period. This agreement will cover “sharing physical specimens and related data, including genetic sequence data, of detected pathogens with epidemic potential for either country within five days of detection”. However, an annex that is supposed to set out the “elements” of the agreement is blank. Bizarrely, the MOUs also want governments to commit to a 25-year “data sharing arrangement” for “exchanging data on the long-term performance of this MOU and for accountability to the United States Congress for appropriated funds”. However, the country grants will only run from 1 April 2026 until 2030. Author Emily Bass published a template for this data-sharing arrangement over the weekend, saying that it “reveals the unprecedentedly extractive nature of these ongoing negotiations”. The US wants access to a range of data, including electronic medical records, health management and information systems, and outbreak response and surveillance data systems. “This agreement affords the US at-will visibility into digital systems, including those, like electronic medical records, that include personal identifiable information,” Bass notes. In the audit section, the MOUs stress that countries need to provide the US with “any data access or information needed to monitor compliance with applicable legal requirements, including to confirm no US government funding is being used for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions”. The MOU concludes by noting that it is not a legally binding document but “a record of the intentions of the parties”. Bypassing WHO? Member states started to negotiate a pathogen access and benefit-sharing system at the WHO headquarters in Geneva recently. By placing itself at the centre of rapid information-sharing about dangerous pathogens, the US appears to be attempting to usurp the World Health Organization (WHO). WHO member states are currently negotiating a Pathogen Access and Benefit Sharing (PABS) system that unite countries, pharmaceutical companies and non-profits in a single process aimed at speedily sharing information and developing counter-measures for pathogens that can cause pandemics. The US and Argentina are the only countries that have opted out of these negotiations. However, if the US is the gatekeeper of pathogen information via these MOUs, this likely to fracture and slow down the global response to pandemics. In addition, US companies could also get the first shot at developing vaccines, therapeutics and diagnostics for these pathogens. Aggrey Aluso of Resilience Action Network Africa (RANA) warned that while governments “should explore deals that could benefit the lives of their people and their economy, such deals should not be extractive”. “Global health security cannot be built on coercive conditionalities,” Aluso told Health Policy Watch. “True preparedness demands equity, respects data sovereignty, and is grounded in solidarity — not transactions that deepen inequities and silence the voices of those most affected. The current version of the proposed MOUs need an inclusive, equity-centred approach.” Health Systems Are Unprepared for The Climate Crisis 14/11/2025 Stefan Anderson The synthesis report follows the launch of the Belém Health Action Plan at COP30, a voluntary best practice framework to assist governments in adapting their health systems for climate change. Nations worldwide must finance and implement climate adaptation measures for health systems or risk losing millions of lives as extreme weather, rising temperatures, and intensifying heat threaten healthcare access for nearly half the global population, according to a report published Friday by the World Health Organization and Brazil. The special report, released at the COP30 summit in Belém, follows Thursday’s launch of the Belém Health Action Plan, which won backing from roughly two dozen countries but secured no financial commitments from governments. The only funding to support the plan came from philanthropies: a $300 million one-time grant. The report estimates health system adaptation needs at $22 billion per year by 2035. “The climate crisis is a health crisis – not in the distant future, but here and now,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This special report provides evidence on the impact of climate change on individuals and health systems, and real-world examples of what countries can do – and are doing – to protect health and strengthen health systems.” The past decade has been the hottest on record, with global temperatures exceeding 1.5°C above pre-industrial levels for the first time in 2024. Updated Climate Tracker projections published at the UN climate summit on Wednesday show the world on track for 2.5°C of warming, while the UN Environment Programme projected last week that a business-as-usual scenario has the world heading for 2.8°C. Every fraction of a degree endangers millions. “Many health systems are fragile, lacking climate-trained personnel, resilient infrastructure and adequate surveillance,” said Simon Stiell, executive secretary of the UN Framework Convention on Climate Change. “Watching super typhoons and flash floods rip through hospitals and local health clinics is heartbreaking, but lamenting is not a strategy. We need real solutions.” Simon Still, executive secretary of the UNFCCC, addresses COP30’s opening plenary. “The real challenges people face, such as extreme heat, air pollution, infectious diseases, mental health and food insecurity – humanity can only win this global climate fight if we connect stronger climate actions to people’s top priorities in their daily lives, and there are few higher priorities than our health,” Stiell said. The report does not present new evidence, functioning instead as a synthesis of the best available science and data on the risks posed to unprepared health systems by climate change, drawing on academic literature, government and UN reports, and real-world case studies. “Recent tragedies show that now is the time to implement policies and actions that address the impacts of climate change on health,” said Alexandre Padilha, Brazil’s health minister. “The Belém Health Action Plan and this report offer countries the tools they need to turn scientific evidence into concrete action.” As storms batter coastlines, floods displace communities, and droughts fuel conflict and hunger, the report paints a picture of health systems under mounting strain. The familiar but alarming statistics form the case to policymakers to invest in adaptation and join the Belém plan. More than 540,000 people now die annually from extreme heat, a 63% rise since the 1990s. Between 3.3 and 3.6 billion people live in regions highly vulnerable to climate change. One in twelve of the world’s 200,000 hospitals face the risk of total shutdown due to extreme weather events under high-emissions scenarios, with more than 70% of at-risk facilities located in low- and middle-income countries. Hospitals and health facilities are also 41% more likely to suffer damage from extreme weather events than in 1990. “Climate change is an unavoidable reality that challenges public health and adds pressure on already overwhelmed systems,” Padilha said, calling policies to protect the health sector one of the “most strategic decisions of the 21st century.” “Protecting lives, reducing inequalities, and bolstering the resilience of health systems are no longer just goals – they have become ethical and democratic imperatives,” he said. Mitigation left out of the main Belém text Brazil’s COP30 presidency chose the Amazon city of Belém in an effort to remind negotiators of the planet they are fighting to protect. While the report and Belém Health Action Plan focus on preparing health systems for climate impacts, the synthesis document draws a clear conclusion about what would most protect those systems: cutting emissions. “The evidence is clear: urgent and sustained mitigation across all sectors is the single most important health adaptation intervention,” states the executive summary. “There are profound physical, financial, and technological limits to adaptation, and health systems cannot remain resilient in a world of unchecked warming.” By reducing emissions, health systems would face less extreme weather events, fewer heat deaths, and smaller disease burdens, making adaptation needs less severe in the first place. That finding sits awkwardly with the Belém Health Action Plan itself, which contains no references to phasing out fossil fuels, the main driver of climate change. The fossil fuel omission came at the explicit instruction of the Brazilian COP30 presidency, according to people familiar with the negotiations, likely to open the door for more nations to sign on who will not commit to language on fossil fuel phase-out. What the report identifies as “the most effective measure” to protect health systems is excluded from the political Belém framework, which requires endorsement from governments, instead relegated to a supporting document with no political weight. “When COP30 delegates leave Belém, success will be measured by the courage governments have demonstrated to act on what is already known: that fossil fuels are destroying people’s health,” said Jeni Miller, health lead at the Global Climate and Health Alliance. “To ignore these realities would be to betray both science and humanity.” A $20 billion gap Adaptation needs for health systems estimated in the COP30 special report. Direct health sector adaptation interventions will require more than $22 billion annually by 2035, according to the report, approximately 7% of total adaptation financing needs in climate-vulnerable countries. Current health-specific climate finance reaching those countries totals around $500 to $700 million annually, representing 2% of adaptation funding and 0.5% of multilateral climate finance. Climate and health finance has grown considerably in recent years, rising tenfold from less than $1 billion in 2018 to $7.1 billion in commitments between 2018 and 2022, according to analysis published earlier this year by the Rockefeller Foundation, WHO and other partners. In 2022, this included $4.8 billion from bilateral donors, $600 million from multilateral development banks, $1.5 billion from multilateral health funds, and $130 million from philanthropies. The share of climate finance targeting the health sector increased from 1% in 2018 to 9% in 2022, the only sector apart from education to see an increase. Yet these flows remain far below estimated needs, and more than 90% of health adaptation funding from development banks arrives as loans rather than grants. “The evidence is clear that we have been too slow to act on climate change and we are now ill-equipped to cope with rising temperatures across the world,” said Alan Dangour, health and climate lead at the Wellcome Trust. The report identifies persistent gaps in readiness. Only 54% of national health adaptation plans assess risks to health facilities. Fewer than 30% of health adaptation studies consider income, 20% consider gender, and less than 1% include people with disabilities. More than 60% of National Adaptation Plans have no formal tracking or evaluation in place. “Extreme heat, air pollution and infectious disease all hit the most vulnerable hardest: children, pregnant people, older adults, outdoor workers, and communities with the fewest resources,” Dangour said. “At COP30 and beyond, governments must act on the science – cut emissions, invest in adaptation, and put health at the heart of climate action. Lives, economies, and our future depend on the solutions we deliver now.” Image Credits: COP30, COP30. How Intimate Partner Violence Affects Children 14/11/2025 Disha Shetty Children’s health suffers in households where their mothers are abused. Noma Bolani has a clear memory of her abusive father stopping the car in the middle of the highway in Durban, South Africa and asking her mother to get out. She was just six years old, but Bolani followed her mother out of the car, and together they sought help from a passing motorist. Bolani is now 38, and has anxiety stemming from early childhood experiences related to growing up with an abusive father and witnessing her mother being at the receiving end of emotional and financial violence. Ayesha*, 34, from New Delhi, India, grew up watching her mother being subjected to physical, emotional and financial violence from her father. He would sometimes also resort to silent treatment that would last weeks, refuse to pay school fees for Ayesha and her sister and resort to physical violence using belts, shoes and, at times, utensils. Ayesha suffers from Polycystic Ovary Disease (PCOD) that affects the regularity of her periods and causes hormonal changes. Her doctor believes the stress she was subjected to as a child played a significant role in worsening her PCOD. Like Bolani, Ayesha also carries mental health scars from watching violence directed at her mother. When mothers are at the receiving end of violence, it can make their children physically ill, according to a growing body of research. Impact on children’s health Health data from 37 countries in sub-Saharan Africa found that children under the age of five whose mothers experienced intimate partner violence (IPV) were more likely to develop diarrhoeal disease and symptoms of acute respiratory infections, according to a study published in The Lancet last year. It called for tailored interventions to address childhood morbidity and mortality attributed to IPV in “priority countries” – Burkina Faso, Burundi, Chad, Comoros, Gabon, Liberia, Nigeria, Sierra Leone, South Africa, and Uganda. “The most important thing is actually the cumulative effect,” said Abel Dadi, lead author and a social epidemiologist at the Menzies School of Health Research at the Charles Darwin University in Australia. His study looked at exposure to three kinds of violence – physical, sexual and emotional. “When they come together, their effect increases,” he said. Dadi’s team also found a strong link between IPV and stunting in Burundi, and IPV and children being underweight in Burkina Faso, although the results were not consistent across all countries. What is not yet clear is the exact pathway of how IPV directed towards the mother affects a child’s physical health. A mother and newborn at a health center in the Patna district of Bihar, India. Babies’ health and well-being is deeply affected by their mother’s health. Pervasive violence The World Health Organization (WHO) recognizes that violence against women is a major public health issue. Globally, one third (27%) of women experience IPV in their lifetime, according to WHO figures. In sub-Saharan Africa, these rates are even higher, with 45·6% of women experiencing IPV in their lifetime. Young women aged 15 to 19 are the most affected by IPV. By the time they are 19 years old, almost a quarter of adolescent girls (24%) who have been in a relationship have already been physically, sexually, or psychologically abused by a partner, according to WHO data. However, while it is widely accepted that intimate partner violence affects a woman’s mental, physical and sexual health at risk, its impact on children has not received the same attention. But a child’s health and well-being are completely dependent on their mother during pregnancy, and heavily dependent in the early years, so a mother’s health and well-being directly affects her child’s health. The WHO, which developed a toolkit with UN Women to prevent violence against women in 2019, acknowledges that violence against women and against children often occurs in the same household. Psychiatrists like Bessel van der Kolk, who wrote ‘The Body Keeps the Score’, and Gabor Mate, author of ‘The Myth of Normal’, have also brought the lifelong impact of childhood trauma into the public domain, particularly of growing up with abusive parents. But IPV has long been seen as a criminal issue rather than a health issue. In India, for example, hospitals have only recently started to offer health workers training to see it as a public health problem. “I don’t think it is a well-understood field of work in terms of a response from the courts or from the state’s response to children’s rights,” said Julie Thekkudan, South Asia consultant at Equality Now, a global non-profit that advocates for women’s and girls’ rights. Each dot represents a different country in the region. There has been progress, with signs that IPV is reducing in some low- and middle-income countries due to progress in women’s empowerment. The reason women find it hard to leave abusive relationships, especially in the Global South, is that they have been socialized to tolerate violence, according to Thekkudan. In societies that favour sons and devalue daughters, girls are socialized into believing that their “purpose in life is to get married”, she explained. Staying in a marriage, even if it is abusive, and seen as part of “making sure that your family honor is maintained”, Thekkudan added. That, in addition to the fact that women don’t always have the financial ability to leave, makes it a harder choice. Dadi said that any intervention design on maternal health should consider intimate partner violence as well as the mental health of the mother. Currently, most of these kinds of interventions are concentrated in high-income countries, according to research. On average, countries that do better on gender equity indexes usually also experienc lower levels of violence against women, according to takeaways published in The Lancet. But a woman’s higher economic status can also make her vulnerable. One study from sub-Saharan Africa showed that women’s employment, especially if they were the sole earners or if they earned more than their male partner, was linked to a higher level of intimate partner violence. Any solution “has to be a multi-pronged, multi-level”, said Thekkudan. “I don’t think there is one solution that will change the entire system or the structure.” *Name changed to protect identity Image Credits: Photo by Alex Pasarelu on Unsplash, BMGF, World Bank. Brazil Wins Limited Backing for COP30 Climate-Health Plan, But Nations Commit No Finance 13/11/2025 Stefan Anderson Belém framework wins backing from two dozen nations, but health remains outside formal UN climate negotiations. Brazil launched a sweeping climate-health action plan on Thursday, named after the COP30 host city in the Amazon, winning initial endorsements from roughly two dozen countries for a voluntary framework calling on nations to strengthen disease surveillance, build climate-resilient infrastructure, and protect vulnerable populations from the health impacts of rising temperatures and extreme weather. The Belém Health Action Plan outlines 60 action items across surveillance systems, evidence-based policies, and health innovation to address the health risks facing 3.3 billion people globally affected by the climate crisis. “The climate crisis is one of the most significant health challenges of our time,” states the plan, developed by Brazil’s health ministry in consultation with the WHO. Countries that endorse the voluntary framework will report their progress through UN climate negotiations during the second Global Stocktake at COP33 in 2028. The World Health Organization calls climate change “the greatest single risk to humanity,” and the World Bank estimates it could cause up to 15.6 million deaths between 2026 and 2050, with health impacts costing $8.6 to $15.4 trillion by mid-century. Initial supporters include European Union states such as France and Spain, small island nations like Tuvalu, African countries from Congo to Zambia, and others including Canada, Japan, the United Kingdom and Malaysia. Brazil’s health minister Alexandre Padilha said the plan had received backing from more than 80 nations and institutions, though the vast majority comprises civil society organisations like the Global Climate and Health Alliance, global health actors including Medicines for Malaria Venture and Drugs for Neglected Diseases Initiative, and UN agencies such as UNFPA, UNICEF and UNITAID. “We expect to have more by the end of the day and the end of the COP,” Padilha said, adding the presidency would continue “trying to engage and mobilise” more countries. “There’s a very strong commitment from our government and ministers of health in this plan.” Delegates gather in the plenary hall of COP30 in Belem for the launch of the Brazil-WHO-led health-climate adaptation plan. The voluntary nature of the framework and broad support for the Alliance for Transformative Action on Climate and Health (ATACH) — a WHO-led initiative launched at COP26, which now counts 101 members — suggest endorsements will likely grow, but implementation remains uncertain. WHO will serve as the secretariat for the Belém plan, measuring outcomes through the ATACH framework. The sole explicit dissent Thursday came from Egypt, part of the Baku coalition of previous COP presidencies that helped draft the plan. Egypt’s health minister expressed willingness to join but voiced “concern about the reference to the inclusion of LGBTIQ+ individuals, as such patterns fall outside the nationally recognised policy frameworks in the cultural context of Egypt.” Other coalition members, the United Arab Emirates and Azerbaijan, expressed political will to continue discussions but stopped short of endorsement, instead noting they had “contributed” and “noted with interest” the framework’s goals. “We have to look at the impact of climate change, one of the main threats to public health in the world today,” Padilha said. “Scientific evidence has shown clearly that the climate crisis is first and foremost a crisis of public health throughout the world.” “The time of warnings has finished. Now we are living in a time of consequences,” he added. “The climate has already changed, so we have no alternative but to have public policies to adapt and face climate change.” No money from nations The voluntary adaptation framework was endorsed by around countries but faces billions in funding shortfalls. The launch came with no new financial commitments from endorsing nations. The sole funding announcement came from a coalition of philanthropies including the Gates Foundation, Wellcome Trust, and Rockefeller Foundation: a $300m one-time grant to support climate-health adaptation measures. That figure is dwarfed by estimates that low- and middle-income countries require at least $11 billion annually just for basic health adaptation covering only disease control for malaria, dengue, diarrheal diseases, heat-related mortality, and essential surveillance improvements, according to the UN Environment Programme. “Health systems, already stretched and underfunded, are struggling to cope with these growing pressures, and most are still unprepared for what is coming,” said Marina Romanello, executive director of the Lancet Countdown at University College London. “Existing finance falls short by billions. Without urgent investment, we will not be able to protect populations from escalating climate impacts.” The $11 billion annual UNEP pricetag excludes respiratory illnesses, malnutrition, mental health services, additional infectious disease programs, workers’ health protection, supply chain adaptation, and health system decarbonisation — most of what the Belém plan contains. The UNFCCC estimates global health adaptation will require $26.8 to 29.4 billion annually by 2050. Current health-specific climate finance reaching those countries totals perhaps $500 to $700 million annually, representing 2% of adaptation funding and 0.5% of multilateral climate finance. “With regards to finance, that reality is that we have a deficit that is quite colossal,” said Carlos Lopes, Special Envoy for Africa to the COP30 Presidency. A WHO survey of National Health Adaptation Plans found all included climate-health risks. But just 28 nations worldwide have completed such plans. As temperatures continue rising and extreme weather events intensify, pressure mounts for health system adaptation at a moment when global health financing faces unprecedented strain. Overall development assistance for health dropped 21% from nearly $50 billion in 2024 to $39 billion in 2025, driven largely by US withdrawal from global health programs. The WHO itself faces budget shortfalls of 15-20%. Climate-health financing has grown from less than $1 billion globally in 2018 to $7.1 billion in 2022, the only aid sector to grow in that time apart from education, according to Rockefeller Foundation analysis. But substantial portions arrive as loans: 24% of bilateral climate-health funding and more than 90% from the Asian Development Bank and Inter-American Development Bank. Many developing countries now spend more on servicing debt than on healthcare, with low-income countries spending roughly 300 times less per capita on health than wealthy nations. That finance shortfall impacts their ability to implement adaptation plans like the Belem Framework: A 2021 WHO survey found that while half of the countries reported having national health-climate strategies, less than a quarter achieved high implementation levels. Insufficient financing was identified as the key barrier by 70% of responding countries. Health’s struggles mirror wider climate adaptation finance gaps. At COP26 in 2021, developed countries pledged to triple overall adaptation finance from 2019 levels to at least $120 billion per year by 2025. Actual flows across all sectors totalled $26 billion in 2023. Money will determine whether Belém becomes an implemented plan or another symbolic declaration. Without tens of billions in annual funding, it will likely follow previous COP health commitments that failed to translate rhetoric into action. “The Belém Health Action Plan gives us the blueprint,” said Simon Stiell, executive secretary of the UN Framework Convention on Climate Change. “What we need now is sustained, coordinated and well-financed action to turn its promises into protection for all.” What’s the plan? Launch event for the Belem Health Action Plan at COP30. The Belém plan functions as a framework of best practice recommendations for adapting health systems to the climate crisis, containing no legally binding requirements or targets. Instead, the document outlines recommendations organized around surveillance systems, policy interventions, and infrastructure overhauls that officials say are essential to protecting billions from climate-driven health crises. The one specific requirement: Countries that endorse it will report progress through the Paris Agreement’s Global Stocktake by COP33 in 2028, with no enforcement mechanisms or compliance requirements. “For decades, WHO has been calling for action to adapt health systems and build resilience to climate change,” said Tedros Adhanom Ghebreyesus, WHO director-general. “The Belém health action plan is how we can do that.” “Health systems themselves are affected by climate change, compromising their ability to deliver life-saving care when people need it most,” he said. “There can be no healthy people on a sick planet.” The first focus: building the capacity to see threats coming. The framework calls for climate-informed health monitoring that links meteorological agencies with health institutions, using predictive modelling to trigger early warnings before heat waves, floods, or disease outbreaks overwhelm communities. Surveillance should also track which populations face the greatest risks, data officials say is often missing. The second area addresses policy interventions to protect communities, including clean energy and sustainable transport, heat protection for workers, mental health support woven into climate response, and targeted measures for Indigenous peoples and persons with disabilities. ”For many countries, adaptation is a question of survival in the short run. If you don’t adapt, it threatens the coverage of health services of patients and professionals who are already facing adverse conditions,” Padhila said. “If we don’t adapt, we are going to increase inequality. In short, if you don’t adapt, we will kill people.” Water & power “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. Finance will determine whether the Belém framework’s most ambitious element, climate-resilient infrastructure, can be delivered. The plan envisions health facilities built to withstand climate shocks, renewable energy powering clinics, telehealth platforms extending care, and strategic stockpiles of temperature-stable medicines and vaccines. It calls for “integrated methodologies linking environmental, meteorological, social, climate and health monitoring data” with real-time surveillance and digital technologies as “structural components.” The problem: roughly 100,000 health facilities in sub-Saharan Africa lack reliable electricity, affecting nearly a billion people worldwide. Up to 70% of medical equipment in developing countries sits unused due to power failures. Cold chains for vaccines, digital surveillance systems, early warning platforms, and telehealth services all depend on reliable power that serving populations don’t have. Closing the healthcare electrification gap by 2030 would cost $4.9 billion, about $5 per person affected over six years. That’s less than one year of current global climate-health spending. “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. “It is very important we have the policies… working on the value chains of electricity to make sure that our babies, who are getting born without electricity,” have access to care. Water and sanitation infrastructure are equally critical, she noted. “If we bring water, we bring sanitation. There is already a disease that we will put away. We can tell our boys and girls to wash their hands, but how could they do it if there is no water at the school?” Just three nations have completed all four ATACH assessments as of 2025. The Belém plan’s success will depend not just on building infrastructure, but on countries’ ability to track and report progress. WHO will measure implementation through ATACH, its Alliance for Transformative Action on Climate and Health, which already requires members to complete vulnerability studies, adaptation plans, emissions inventories, and decarbonization roadmaps. The record so far suggests those demands exceed many countries’ capacity. Four years after ATACH’s launch in 2021, only three countries—France, Japan, and the UK—have completed all four assessments. Across 88 countries with available data, roughly 35-40% completed vulnerability assessments and 30% finished adaptation plans. In Africa, fewer than 10 of 29 ATACH members have completed vulnerability assessments. The Belém plan now adds reporting requirements on top of those existing gaps: tracking mental health impacts, monitoring workers’ heat exposure, establishing community resilience programmes, and climate-proofing supply chains, all by 2028. That creates an impossible bind. France, Japan, and the UK have the technical capacity and resources to meet these demands. Many other countries lack not only the expertise for complex reporting systems, but the basic infrastructure, electricity and water, that the plan assumes as a foundation. “Finance is still the bottleneck for us,” Princess Djigma said. Fossil fuel phase-out excluded Delegates arrive for the opening day of COP30 on the edge of the Brazilian Amazon. Notably absent from the plan is any reference to phasing out fossil fuels, the main driver of climate change and the resulting heat, extreme weather and air pollution killing approximately 8m people annually from respiratory and cardiovascular diseases. The omission came at the explicit instruction of the Brazilian COP30 presidency, according to people familiar with the negotiations. The exclusion comes as the International Energy Agency warned Wednesday that global oil and gas demand will rise for the next 25 years if countries do not change course. Until this year, all of the Paris-based body’s modelling assumed fossil fuel consumption would peak this decade. “Climate change is declining — and declining rapidly — in the international energy policy agenda,” said Fatih Birol, the IEA’s executive director. “And this is happening while 2024 was the hottest year in history.” Fifteen countries allocated more resources to fossil fuel net subsidies than their entire national health budgets. Birol’s findings align with the Lancet Countdown report published ahead of the summit, which found the 100 largest oil and gas companies have production strategies that put them on track to exceed their share of production consistent with 1.5 °C of heating by 189% in 2040, up from 183% in March 2024. Private bank lending to fossil fuel activities surged 29% to $611 billion in 2024, exceeding green sector lending by 15%. Some 73 of 87 countries reviewed provided net explicit fossil fuel subsidies in 2023, allocating nearly $1 trillion in direct support. Including indirect subsidies, that figure rises to over $7tn, according to the International Monetary Fund — more than governments spend annually on education and about two-thirds of what they spend on healthcare. The declining political attention extends to international engagement: Mentions of health and climate change by governments in their annual UN General Assembly statements declined from 62% in 2021 to 30% in 2024, according to the Lancet Countdown. “Record deaths from climate-driven wildfires in 2023 show that there’s no adaptation without mitigation,” said Nina Renshaw, head of health at the Clean Air Fund. “Ministries of Health and Finance won’t be able to bail hospitals and clinics out of the climate emergency if governments don’t stop the emissions which are already causing unprecedented harm.” ‘More than dialogue’ Delegates convened for the first-ever Health Day at a UN climate summit in Dubai. The Belém plan follows a pattern established at recent climate summits: the COP28 Dubai Health Declaration signed by 143 countries, the Baku Coalition for Climate and Health launched last year, and efforts stretching back to Glasgow in 2021. Like those efforts, Belém is a non-binding, voluntary process taking place outside formal UN negotiations. Criticisms of the outcomes of Dubai and Baku describe their outcomes as symbolic gestures that generate attention but fail to secure funding, sustained commitment, or implementation. Officials on Thursday repeatedly stressed the need to break the holding pattern. “This gathering must be more than dialogue,” said Jarbas Barbosa, director of the Pan American Health Organization. “It must galvanise collective action and inspire new policies dedicated to protecting everyone’s health from the worsening effects of climate change.” “The climatic crisis is fundamentally a health crisis,” Barbosa said. “We are not talking any more about distant or possible threats. Climate change is a present and growing reality.” Whether the Belém framework can overcome the obstacles that have stymied previous declarations — insufficient financing, limited technical capacity, competing priorities — remains uncertain. But Padilha argued the world has no choice but to try. “We are faced with a dilemma: we either continue to speak and speak and talk, or we can walk the walk and make the political commitment to do so,” he said. “We cannot accept the erosion of multilateralism in global health. Those who deny multilateralism are surrounding us. We will not listen to them.” Image Credits: COP30, COP30, COP30, COP30, COP30, COP30, WHO . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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South Africa May Be Excluded From Future US Grants for HIV Amid Political Row 21/11/2025 Kerry Cullinan South Africa may be excluded from future PEPFAR grants as its relations with the US deteriorate. The United States (US) government has not sought a meeting with South Africa to discuss the resumption of its HIV grant, and it won’t supply the country with the long-acting HIV prevention medication, lenacapavir, amid a deepening political row between the two countries. While US Ambassadors throughout the continent have initiated meetings with African Health Ministers to discuss Memorandums of Understanding (MOU) to set out new terms for the continuation of their US President’s Emergency Plan for AIDS Relief (PEPFAR) grants from April 2026, South Africa has not received such an invitation. “The Department of Health has not received any correspondence from the US government regarding PEPFAR discussions,” Foster Mohale, South Africa’s Health Ministry spokesperson, told Health Policy Watch. A US State Department spokesperson told Health Policy Watch that the US government “is still deliberating future health assistance to South Africa pending broader bilateral discussions”. “The State Department approved the PEPFAR Bridge Plan for South Africa for a six-month implementation period, spanning from 1 October 2025, to 31 March, 2026. The $115 million allocated under this plan supports core life-saving HIV services,” according to the US State Department spokesperson. “The Bridge Plan prioritises service continuity with minimal programmatic changes, focusing on country-specific needs and maximising life-saving impact.” In relation to whether the US would provide lenacapavir to South Africa, a US Embassy spokesperson provided a comment by Jeremy Lewin, Under Secretary for Foreign Assistance, Humanitarian Affairs, and Religious Freedom, stating that the US “will not be contributing doses to South Africa”. “Obviously, we encourage every country, especially countries like South Africa, that have significant means of their own to fund doses for their own population of this innovative American-made drug that Gilead has developed. US-funded doses will not be going to South Africa,” Lewin told a media briefing on 17 November, the day the first 1,000 lenacapavir doses were delivered in Eswatini and Zambia. The US will provide lenacapavir to Eswatini, Kenya, Lesotho, Malawi, Mozambique, Philippines, Uganda, Ukraine, Zambia, and Zimbabwe. Largest HIV+ population A patient getting an HIV test at Witkoppen Clinic, which received PEPFAR for HIV-related services. Around eight million South Africans are living with HIV, around 13% of the population – the largest HIV positive community in the world. In 2024, South Africa received $453 million in PEPFAR funding, and $439 million had been allocated for 2025. But this was suspended when Donald Trump became president on 20 January. In October, the US government approved a $115 million “PEPFAR Bridge Plan” for South Africa for six months from 1 October to 31 March 2026. Relations between the US and South Africa have been rocky since Trump took office, signing an executive order in February to “halt foreign aid or assistance delivered or provided to South Africa”. The order incorrectly claims that South Africa is persecuting white Afrikaners, and has “taken aggressive positions towards the United States and its allies, including accusing Israel, not Hamas, of genocide in the International Court of Justice”. The US has offered white Afrikaners refuge in the US, and Trump has made several disparaging remarks about the country, including at a meeting at the White House with South African President Cyril Ramaphosa. Earlier this month, the US pulled out of the G20 meeting being hosted in South Africa this weekend, with Trump repeating incorrect claims of discrimination against whites as the reason. All 2026 lenacapvir stock bought Lenacapavir, packaged as Sunlenca in the US, where is sells for $42,250 for two injections. The US government and the Global Fund have bought all of Gilead’s 2026 stock of lenacapavir, a twice-a-year injectable that is almost 100% successful in preventing HIV transmission. The Global Fund’s HIV head, Izukanji Sikazwe, told Health Policy Watch that her organisation will supply South Africa and all countries in need with lenacapavir “based on evidence of need”. But eight patient advocacy groups described the rollout of 500 lenacapavir doses each for Eswatini and Zambia as a “public relations stunt” in a media release on Thursday. “Africa and the Global South are being offered merely symbolic handouts, while Gilead and donors shape markets to serve corporate and geopolitical interests, not urgent public health needs,” said Fatima Hassan, director of the Health Justice Initiative (HJI). “By procuring a minuscule number of doses, Gilead can claim that [lenacapavir] is ‘introduced’ in Africa, creating demand and laying the path for commercial bullying instead of introducing the product at actual cost and at scale. This is a profit-seeking, corporate strategy dressed up as solidarity,” she added. Gilead announced in October 2024 that it has authorised six generic manufacturers to sell lenacapavir in 120 low- and middle-income countries, although none are from sub-Saharan Africa. It also excluded several Latin American countries including Brazil and Colombia. The medicine is licensed in the US as Sunlenca for people with drug-resistant HIV, and currently costs $42,250 a year for two injections. The generics are only likely to be available in 2027 at the earliest, and the advocacy groups claim Gilead is “frustrating the speed at which generic entries are possible”, as it has not yet filed an application with India’s drug regulatory authority and has prioritised registration in only 22 countries. ‘Insulting’ The advocacy groups estimate that at least 10 million Africans need lenacapavir to achieve the global goal of a 90% reduction in new HIV infections by 2030, with two million of these being South Africans. However, the US will only provide doses for 325,000 people in 2026 – an “insulting” amount in comparison to the need, said Bellinda Thibela, Health GAP’s International Policy and Advocacy coordinator. “Instead of crumbs, the US should be providing millions of lenacapavir doses, to alter the course of the HIV pandemic and to repair the harms caused by their illegal and deadly cuts to HIV programmes since January,” added Thibela. However, Brad Smith, US Senior Advisor for the Bureau of Global Health Security and Diplomacy, told a media briefing this week that Gilead’s available volume in 2026 is 600,000 doses, but that the US and the Global Fund are committed to buying two million doses. “We anticipate a continued increase in demand and production capability over time to enable us to meet the two million doses sometime in mid-2027,” said Smith, adding that the doses were being split 50/50 between the US and the Global Fund. “We are working out between ourselves exactly who will distribute and procure for which country,” Smith added. Speaking at the same media briefing, Gilead CEO Daniel O’Day said his company was able to “provide Lenacapavir at no profit to Gilead to the countries with the highest burden of HIV”. US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenya. Political decisions Citing the US Executive Order against South Africa, the advocacy groups say that the US has made the country “the target of harsh foreign policy decisions based on the Trump administration’s racism, lies, and conspiracy theories”. Nigeria is also being “pushed out” of lenacapavir support “after being criticised by US government officials, including for refusing to imprison US detainees extracted during US immigration raids”, they claim. “In contrast, Eswatini has accepted the offer of not just the 500 lenacapavir doses ahead of World AIDS Day, but also $5.1 million in funding from the US government in exchange for imprisoning US detainees,” they note. Sibongile Tshabalala, Chairperson of the Treatment Action Campaign (TAC), called for either Gilead to license South African generic companies to make lenacapavir, or for the South African government to “use its lawful powers to issue compulsory licenses”. “Now that the Trump administration has openly tied the global rollout of lenacapavir to a political standoff rewarding ‘compliance’ but punishing African political autonomy and sovereignty, South Africa must step forward with principled global leadership,” the groups add. This story has been updated to include the US State Department’s comment. Image Credits: The Global Fund/ Saiba Sehmi, International AIDS Society, Witkoppen Clinic, Gilead. Global Fund Seeks $14 Billion at Replenishment Summit – With Progress Against HIV, TB and Malaria at Risk 20/11/2025 Kerry Cullinan Deborah and her 10-month-old daughter Catherine at the Baylor College of Medicine Children’s Foundation in Lilongwe, Malawi. Deborah is living with HIV and Catherine is on preventive treatment. JOHANNESBURG – The Global Fund (GF) has only raised $4 billion of its $18 billion budget for the next three years – so much is riding on its Replenishment Summit in Johannesburg on Friday (21 November) as it seeks the balance to advance progress against HIV, tuberculosis (TB) and malaria. The United States has been the largest donor to the Global Fund, contributing around one-third of its budget – but whether it will still contribute generously is an open question, given the Trump administration’s “America First” focus. “We have been in almost constant dialogue with the US since the beginning of the year, and we have not received any stop-work order or any sort of notification that the funding will be stopped,” Francoise Vanni, the Fund’s external relations and communications director, told a media briefing in Johannesburg on Thursday. “We are confident that they will pledge to the Replenishment tomorrow,” added Vanni, pointing out that the US and the GF are working closely to roll out the long-acting HIV prevention medicine, lenacapavir, in several African countries. South Africa and the United Kingdom (UK) are co-hosting the Replenishment, but that did not prevent the UK from cutting its contribution by 15%. The Fund provides 73% of all international financing for TB, 60% for malaria and 24% for HIV. Médecins Sans Frontières (MSF) has described initial pledges as “deeply concerning”. “Germany and the United Kingdom – the only major traditional donors to pledge so far – have both decreased their commitments compared to the last cycle. Specifically, Germany has pledged €1 billion instead of €1.3 billion and the UK has pledged £850 million instead of £1 billion,” MSF noted on Thursday. “No donor has increased their pledge when considering inflation. If other major donors follow Germany and the UK’s examples, the results would be catastrophic for people impacted by TB, HIV, and malaria worldwide,” MSF said. “Failure to meet this [$14 billion] goal would risk catastrophic cuts to essential services, threaten the resurgence of HIV, TB, and malaria – the world’s top three deadliest infectious diseases – and put the financial burden of health care onto the world’s most vulnerable patients.” Members of a spray team prepare their equipment before spraying homes with insecticide to protect families from malaria in Kaukira, Honduras. Saving 70 million lives The GF is the world’s largest funder of global health, and it has saved an estimated 70 million lives since its establishment 22 years ago, according to its Results Report 2025. Around $103 billion has also been saved in reduced hospitalisations, freeing countries’ health systems to address other diseases and other health needs, Vanni noted. While it works in over 100 countries, its effect has been felt primarily in Africa, where 73% of its budget has been spent. In 15 priority countries in sub-Saharan Africa, life expectancy has increased from 49 years old in 2001 to 61 in 2021 – mostly thanks to people with HIV getting access to antiretroviral medicine. In Zambia, for example, life expectancy has increased by 19 years from 43 to 58 years. Since the GF was launched in 2002, AIDS-related deaths have been reduced by almost three-quarters in the countries where the Global Fund operates, and new infections have been reduced by 62%. Without these interventions, AIDS deaths would have increased by 90% and new HIV infections by 75% over the same period. In 2024 alone, Fund-supported TB programmes treated 7.4 million people with TB. Between 2002 and 2023, GF efforts have reduced TB deaths by 40%. Without these, TB deaths would have increased by 134% and TB cases by 40% over the same period. Malaria deaths were reduced by 29% between 2002 and 2023, “even though the population in these countries has increased by 46%”, the Results Report notes. “Without malaria control measures, deaths would have increased by 94% over the same period.” Malaria ‘way off target’ Despite progress, HIV, TB and malaria remain the world’s deadliest infectious diseases. The $18 billion budget could save 23 million lives between 2027 and 2029, avert 400 million new infections and result in a 1:19 return on investment across the three diseases, according to Fund modelling. “Malaria is way off track, with 600,000 people a year dying,” admits Kate Kolaczinski, the Fund’s senior specialist on the disease. “Malaria is the leading cause of outpatient visits in sub-Saharan Africa,” she adds, with 263 million malaria cases in 2023. Between 2002 and 2023, malaria cases in countries supported by the Global Fund increased by 8% “Rising conflict, disruptions from extreme weather events and increasing resistance to antimalarial drugs and insecticides have complicated efforts to combat malaria in 2024,” according to the Results Report 2025. “The goal of ending [malaria] by 2030 looks daunting. Reductions in global health funding could undermine progress against malaria. A widening funding gap, combined with existing crises and an expected population growth in areas at high-risk of malaria, could threaten the lives of millions.” President Duma Boko of Botswana has urged countries to support the Replenishment, noting in an exclusive article for Health Policy Watch: “If the world retreats now, an additional 750,000 children in Africa could die by 2030, and our economies could lose $83 billion in GDP if funding is so low that all prevention interventions are halted.” HIV resurgence? “There’s a risk of HIV resurgence, especially now that we have funding challenges that we’re facing,” says the Fund’s HIV head, Izukanji Sikazwe, pointing out that 9.2 million people living with HIV still need access to treatment. “We are off target for HIV prevention. In 2024, there were 1.3 million new infections. We need a fourfold reduction to meet the 2025 target of 370,000.” Meanwhile, TB surged during the COVID-19 pandemic and but 2024 brought new progress against the disease. “Robust funding commitments in 2025 are absolutely critical to maintaining our momentum against TB and preventing a resurgence that could undo decades of hard-won progress,” according to the Results Report 2025. It describes an “exciting pipeline of innovative tools”, including new TB tests, better treatments and “at least five TB vaccines in phase III efficacy trials”. Private sector contributions While the bulk of the Fund’s budget comes from country contributions, the private sector also contributes – with the Gates Foundation being the biggest and most consistent private donor, contributing $3.91 billion since 2002. “The Global Fund will go down in history as one of humanity’s biggest achievements. It’s also one of the kindest things people have ever done for each other,” according to Gates Foundation chair Bill Gates. The Global Fund’s track record proves it is an excellent investment for our global health dollars. Its work is critical to achieving the goal of ending AIDS, TB and malaria, and making our world a more equitable place for people everywhere.” The Children’s Investment Fund Foundation (CIFF) has significantly increased its contribution recently, focusing on expanding access to lenacapavir by both supporting procurement and the development of generics. John Fairhurst, who heads the Fund’s private sector mobilisation, says that the sector has contributed over $5.3 billion in the past 20 years – often playing a “catalytic role” in innovation. Unlike countries, which give unrestricted funds, private donors can earmark their contributions. Image Credits: Tommy Trenchard/ Global Fund, Global Fund. World Falls Far Short of Methane Cut Targets Halfway to 2030 Deadline 18/11/2025 Stefan Anderson Infrared camera reveals escaped methane emissions from oil rig. Methane leaks from oil and gas make a major contribution to global warming. First UN assessment since the 2021 Glasgow pledge shows methane cuts falling far short of targets needed to meet climate goals. Accelerated action could yield $330 billion in annual benefits by 2030 through improved health and reduced crop losses. Four years after more than 100 countries pledged to slash methane emissions 30% by the end of the decade, a UN assessment has found nations are on track to deliver barely a quarter of that target. The Global Methane Status Report, released Monday at COP30 in the Brazilian Amazon city of Belém, found that current national commitments would cut global methane emissions by just 8% below 2020 levels by 2030. Despite the lack of progress, the 30% target remains technically achievable with increased investment and policy-driven reform, the report found, adding it could yield some $330 billion in benefits to health and cost production, nearly double the cost of investment in methane emissions mitigation. While methane emissions are not a part of formal negotiations in the UN Framework Convention on Climate Change (UNFCC)C, it is the world’s second largest contributor to global warming, after CO2, with a global warming potential 86 times greater. A precursor to ground-level ozone formation, methane is a contributor to air pollution-related deaths as well as reduced crop yields. With an atmospheric lifespan of only about 12 years, reducing methane emissions can yield enormous co-benefits for health as well as reducing the pace of climate change. Collective, non-binding target The Global Methane Status Report produced by the UN Environment Programme is the first comprehensive stocktake of global progress on methane emissions since reduction targets were announced at COP26. The assessment comes as global methane concentrations have reached the highest levels in at least 800,000 years, more than 2.6 times pre-industrial levels, with the gas responsible for roughly one-third of present-day global warming. The new report compiled by the UN Environment Programme is the first comprehensive stocktake since the Global Methane Pledge was launched at the UN climate summit in Glasgow, COP26. The Global Methane Pledge, a non-binding political commitment signed by 159 countries, set a collective global reduction target rather than assigning specific cuts to individual countries or sectors, leaving nations to develop their own strategies and action plans. “Slow climate action means that the multi-decade average of global temperatures will exceed 1.5°C within the next decade,” Ruth do Cutto, deputy climate change chief at UNEP said at a press briefing launching the report. “We must make sure that this overshoot is as short and as low in temperature as possible, and we cannot do that without curbing emissions of methane, which is responsible for one-third of today’s global warming.” Methane’s potency as a greenhouse gas, combined with its relatively short atmospheric lifespan, makes cutting emissions one of the fastest ways to slow near-term temperature rise, often called an environmental “hand brake” by climate experts. “Lack of time is our biggest challenge,” said COP30 President Ana Toni, noting that slashing methane emissions “delivers the fastest results” for slowing warming. Full deployment of what the report calls “maximum technically feasible reductions” could still cut emissions 32% below 2020 levels by 2030, even surpassing the pledge target. These measures would cost an estimated $127 billion annually but deliver benefits valued at $330 billion per year by 2030, including preventing more than 180,000 premature deaths, avoiding 19 million tonnes of crop losses, and reducing global temperatures by 0.2°C by mid-century. “We’re on a highway to hell with the foot on the gas pedal,” Martina Otto, head of the Climate and Clean Air Coalition Secretariat, which produced the report with the UN Environment Programme, said at the launch event in Belém. “If we are heading towards the wall, you don’t just pull the handbrake a little bit. You pull it forcefully and fast. And I think that’s where we are right now,” Otto said. Slow momentum, US wildcard The 159 countries now signed to the pledge, up from just over 100 at launch, represent nearly half of global methane emissions. However, three of the world’s top five emitters remain outside the agreement: China, the largest overall source, India and Russia. China’s participation in a methane summit co-hosted with Brazil and the United Kingdom on the sidelines of COP30 marked a notable diplomatic shift, though Beijing has yet to sign the global methane pledge. Since the pledge’s launch, projected 2030 emissions have improved modestly. Some 127 countries, representing 65% of Paris Agreement parties, now include methane mitigation measures in their latest Nationally Determined Contributions, a 38% increase from pre-2020 levels. New waste management regulations in Europe and North America, combined with slower-than-expected growth in natural gas markets between 2020 and 2024, have lowered forecast emission levels by 14 million tonnes compared with 2021 projections, UNEP found. The emissions decrease documented in the report is relative to levels projected in 2021, not a net reduction. While methane emissions were on track to increase by 13% by 2030, that would fall to 5% if nations follow through on pledged cuts. Overall, global methane emissions continue to rise, reaching approximately 352 million tonnes in 2020 and projected to hit 369 million tonnes by 2030 under current legislation. “If countries fully implement their existing methane plans submitted as of June 2025, global emissions could fall by about 8% this decade,” Otto said. “That would constitute the largest and most sustained decline in methane emissions ever recorded. So it works, but it doesn’t work fast enough.” The report’s modelling does not account for the United States reversing its methane commitments. While the US was once a leading nation in advocating methane emissions cuts and a core author of the 2021 pledge in Glasgow, the Trump administration has rolled back domestic methane policies and pressured the European Union to delay implementation of new methane emissions regulations that would increase reporting transparency. Some US states, including California, have maintained stricter methane reporting requirements. Agriculture, energy and waste lead methane-emitting sectors Global anthropogenic methane emissions in the current policies scenario, 1990–2050, million tonnes per year The UNEP report found that agriculture accounts for 42% of global methane emissions, the energy sector 38%, and waste 20%. The G20 countries plus the European Union and several other developed nations are responsible for 65% of total emissions, with China taking the top spot. The energy sector offers the largest mitigation opportunity, UNEP said, with 72% of technically feasible reductions by 2030 concentrated in oil, gas and coal operations. More than 80% of the total reduction potential across all sectors can be achieved at costs below $36 per tonne of CO2 equivalent, with many fossil fuel measures actually profitable because they capture gas that can be sold rather than vented or flared. Inger Andersen, executive director of UNEP, said “reducing methane emissions is one of the most immediate and effective steps we can take to slow the climate crisis while protecting human health.” Chloe Brimicombe, a climate scientist at the Royal Meteorological Society, linked methane emissions to more frequent and intense heatwaves, which kill nearly 600,000 people annually. “Heat puts immense stress on the body, particularly for children, older people and those with chronic illness,” she said, describing methane cuts as a “fast and effective way to help protect communities from heat-related illness and deaths.” “Reducing methane decreases the precursors of ground-level ozone, reducing cardiovascular and respiratory disease immediately,” said Courtney Howard, an emergency physician and chair of the Global Climate and Health Alliance. “Cutting methane is a win-win for health and health systems now and into the future.” ‘On the radar’ Global anthropogenic methane emissions under different scenarios, 1990–2050, million tonnes per year. Regional studies “continue to reveal significant underreporting of methane emissions, particularly within the fossil fuel sector,” the report found. Dan Jørgensen, European Commissioner for Energy and Housing, said nearly 90% of satellite-detected emission events still go unaddressed by governments and fossil-fuel companies. Liz Thompson, climate ambassador of Barbados, called reining in these oversights a “matter of survival” for small island nations. “We need oil and gas companies to recognise the importance of cutting methane emissions by stopping flaring and leaks,” she said. “Over the next year, we must advance discussions so that COP31 can perhaps present a concrete proposal to initiate efforts that will lead to a legally binding agreement.” Current methane-focused investment has reached $13.7 billion annually, up 18% in recent years but far below the $127 billion needed by 2030. Measures in the fossil fuel sector could be deployed at little to no net cost, with bills for the energy sector overall representing just 2 to 4% of the industry’s 2023 income, according to the report. “It shows that methane has made it onto the radar and that we’ve gained momentum, that cost-effective solutions exist today, essentially waiting to be brought to scale, and that the benefits are enormous,” Otto said. “We can do it, but we have to act much faster.” China’s participation in COP30 methane summit marks a shift The report launch coincided with a “methane summit’’ co-hosted by Brazil, China and the United Kingdom on the sidelines of COP30. The summit launched a “Super Pollutant Country Action Accelerator” providing $25 million in initial funding for seven developing countries to establish dedicated national methane units, modelled on the successful Montreal Protocol ozone programmes. China’s participation marked a significant diplomatic development, as Beijing co-hosted the event despite not being a signatory to the Global Methane Pledge. The country is the world’s largest methane emitter, primarily from its massive coal mining sector. “The summit not only underscores the critical role of controlling methane and other non-CO2 greenhouse gas emissions in the global response to climate change, but also encourages all parties to share the policies and actions they have taken in the emission reduction process,” Huang Runqiu, China’s environment chief, said at the summit. “Climate change is a global challenge, and addressing it requires concerted efforts from the entire world.” The UK also led a statement signed by Canada, France, Germany, Japan, Kazakhstan and Norway committing to drastically reduce methane emissions in the fossil fuel sector, including ending routine flaring and venting by 2030 and developing a “near-zero methane intensity marketplace” by 2026 to use trade measures to reward low-emission producers. “The global methane pledge has had an impact. It supported the reshaping of national priorities,” Otto said. However, she noted the report had to exclude the latest round of national climate plans submitted after June 2025 from its modelling. “Obviously, we have seen new coming in, but we had to do the modelling at one point, and so that became our cut-off.” Beyond 2030, the report warned that technical fixes alone will prove insufficient. Meeting 1.5C or 2C warming targets will require combining methane controls with broader energy decarbonisation and demand-side measures, including dietary shifts and reduced food waste, potentially cutting emissions 53% below 2020 levels by 2050. “We can still make it,” Otto said. “But it will take a whole lot of additional effort. It’s not possible if we do it half-heartedly.” With five years remaining until the 2030 target, “the choices made in the next five years will determine whether the world seizes this opportunity, unlocking cleaner air, stronger economies, and a safer climate for generations to come,” UNEP concluded. Image Credits: Clean Air Task Force . Former DOGE Official Driving US Bilateral Health Agreements With African Countries 17/11/2025 Kerry Cullinan US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenyan Treasury and health officials. The United States government is moving rapidly to secure Memorandums of Understanding (MOU) with African countries that offer limited health aid for five years in exchange for 25 years’ access to countries’ data about “pathogens with epidemic potential”. Some commentators have described the terms of the bilateral MOUs as “extractive” as they fail to offer African countries access to the health products that might be developed from the pathogen material that they share. The process is being driven by Brad Smith, formerly one of the leaders of Elon Musk’s Department of Government Efficiency (DOGE), who was responsible for implementing deep cuts to the US Health and Human Services (HHS) department. Smith is now a global health advisor in the US State Department, overseeing the reorganisation of the US President’s Emergency Plan for AIDS Relief (PEPFAR) and health grants from the now defunct US Agency for International Development (USAID). He was part of the US delegation that met Kenyan health and finance officials last week to discuss its MOU. So too was Bethany Kozma, a former USAID official during the first Trump administration and a fervent anti-abortion campaigner. She is currently chief advisor for policy and strategy in the HHS Global Affairs Office. Bethany Kozma, anti-abortion campaigner and chief advisor for policy and strategy in the HHS Global Affairs Office, also attended the meeting with Kenya. Dr Chris Kiptoo, Kenyan Treasury’s Principal Secretary, reported after last week’s meeting that “both countries are finalising a bilateral agreement that aligns Kenya’s health priorities with the United States’ global health objectives, strengthening a partnership that saves lives and builds a more resilient health system for our nation”. Meanwhile, Rwandan Health Minister Dr Sabin Nsanzimana met a US delegation headed by Dr Mamadi Yilla, US State Department deputy assistant secretary for health diplomacy, last week to discuss a new MOU. Rwandan Health Minister Dr Sabin Nsanzimana and Dr Mamadi Yilla, US deputy assistant secretary for global health diplomacy and other officials. Smith also led the US delegation to Zambia on Monday (17 November), where he met Zambia’s Health Minister, Dr Elijah Muchima, and Finance Minister Situmbeko Musokotwane. The meeting aimed to “chart a new course for US health assistance to Zambia”, according to the US Embassy in Zambia. “The new approach envisions both governments committing to funding levels and health outcome performance objectives in order to accelerate the transition from an aid-dependent health sector to a Zambian government-led health system that is able to sustainably meet the health needs of the Zambian people,” according to the US media release. US official Brad Smith and Zambian Finance Minister Situmbeko Musokotwane. Extensive access to data The MOUs include clauses that would give the US extensive access to country health databases and contain punitive measures for countries that fail to provide this access or pathogen information, including unspecified “changes in the planned assistance” or total discontinuation of aid. Conversely, those that meet targets may get unspecified rewards. While the agreements contain a list of targets (“outcome metrics) for reducing HIV, TB, malaria, maternal and under-five mortality, and increasing measles vaccinations, details about how these will be achieved are scanty. In contrast to the health services section, the “surveillance and outbreak response” section is far more detailed, with budget allocations and staff numbers. For instance, Zambia is expected to employ “1,723 field epidemiologists” in 2026 at its own expense to meet its outbreak surveillance and pathogen-sharing requirements, according to a draft seen by Health Policy Watch. The US also notes in the draft Zambian MOU that it is making a $50 million cut to its previous commitment of $120 million in funding for antiretroviral (ARV) medicine and HIV tests due to “historic theft”. This relates to a 2021 scandal where it emerged that ARVs donated to Zambia were being sold in pharmacies. Countries need the capacity to detect disease outbreaks within seven days and report to the US on these within a day of an outbreak being detected, according to the MOUs. Twenty-five years’ access for five-year grants Countries also have to commit to signing a 25-year “specimen sharing agreement”, although the MOUs only cover a five-year grant period. This agreement will cover “sharing physical specimens and related data, including genetic sequence data, of detected pathogens with epidemic potential for either country within five days of detection”. However, an annex that is supposed to set out the “elements” of the agreement is blank. Bizarrely, the MOUs also want governments to commit to a 25-year “data sharing arrangement” for “exchanging data on the long-term performance of this MOU and for accountability to the United States Congress for appropriated funds”. However, the country grants will only run from 1 April 2026 until 2030. Author Emily Bass published a template for this data-sharing arrangement over the weekend, saying that it “reveals the unprecedentedly extractive nature of these ongoing negotiations”. The US wants access to a range of data, including electronic medical records, health management and information systems, and outbreak response and surveillance data systems. “This agreement affords the US at-will visibility into digital systems, including those, like electronic medical records, that include personal identifiable information,” Bass notes. In the audit section, the MOUs stress that countries need to provide the US with “any data access or information needed to monitor compliance with applicable legal requirements, including to confirm no US government funding is being used for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions”. The MOU concludes by noting that it is not a legally binding document but “a record of the intentions of the parties”. Bypassing WHO? Member states started to negotiate a pathogen access and benefit-sharing system at the WHO headquarters in Geneva recently. By placing itself at the centre of rapid information-sharing about dangerous pathogens, the US appears to be attempting to usurp the World Health Organization (WHO). WHO member states are currently negotiating a Pathogen Access and Benefit Sharing (PABS) system that unite countries, pharmaceutical companies and non-profits in a single process aimed at speedily sharing information and developing counter-measures for pathogens that can cause pandemics. The US and Argentina are the only countries that have opted out of these negotiations. However, if the US is the gatekeeper of pathogen information via these MOUs, this likely to fracture and slow down the global response to pandemics. In addition, US companies could also get the first shot at developing vaccines, therapeutics and diagnostics for these pathogens. Aggrey Aluso of Resilience Action Network Africa (RANA) warned that while governments “should explore deals that could benefit the lives of their people and their economy, such deals should not be extractive”. “Global health security cannot be built on coercive conditionalities,” Aluso told Health Policy Watch. “True preparedness demands equity, respects data sovereignty, and is grounded in solidarity — not transactions that deepen inequities and silence the voices of those most affected. The current version of the proposed MOUs need an inclusive, equity-centred approach.” Health Systems Are Unprepared for The Climate Crisis 14/11/2025 Stefan Anderson The synthesis report follows the launch of the Belém Health Action Plan at COP30, a voluntary best practice framework to assist governments in adapting their health systems for climate change. Nations worldwide must finance and implement climate adaptation measures for health systems or risk losing millions of lives as extreme weather, rising temperatures, and intensifying heat threaten healthcare access for nearly half the global population, according to a report published Friday by the World Health Organization and Brazil. The special report, released at the COP30 summit in Belém, follows Thursday’s launch of the Belém Health Action Plan, which won backing from roughly two dozen countries but secured no financial commitments from governments. The only funding to support the plan came from philanthropies: a $300 million one-time grant. The report estimates health system adaptation needs at $22 billion per year by 2035. “The climate crisis is a health crisis – not in the distant future, but here and now,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This special report provides evidence on the impact of climate change on individuals and health systems, and real-world examples of what countries can do – and are doing – to protect health and strengthen health systems.” The past decade has been the hottest on record, with global temperatures exceeding 1.5°C above pre-industrial levels for the first time in 2024. Updated Climate Tracker projections published at the UN climate summit on Wednesday show the world on track for 2.5°C of warming, while the UN Environment Programme projected last week that a business-as-usual scenario has the world heading for 2.8°C. Every fraction of a degree endangers millions. “Many health systems are fragile, lacking climate-trained personnel, resilient infrastructure and adequate surveillance,” said Simon Stiell, executive secretary of the UN Framework Convention on Climate Change. “Watching super typhoons and flash floods rip through hospitals and local health clinics is heartbreaking, but lamenting is not a strategy. We need real solutions.” Simon Still, executive secretary of the UNFCCC, addresses COP30’s opening plenary. “The real challenges people face, such as extreme heat, air pollution, infectious diseases, mental health and food insecurity – humanity can only win this global climate fight if we connect stronger climate actions to people’s top priorities in their daily lives, and there are few higher priorities than our health,” Stiell said. The report does not present new evidence, functioning instead as a synthesis of the best available science and data on the risks posed to unprepared health systems by climate change, drawing on academic literature, government and UN reports, and real-world case studies. “Recent tragedies show that now is the time to implement policies and actions that address the impacts of climate change on health,” said Alexandre Padilha, Brazil’s health minister. “The Belém Health Action Plan and this report offer countries the tools they need to turn scientific evidence into concrete action.” As storms batter coastlines, floods displace communities, and droughts fuel conflict and hunger, the report paints a picture of health systems under mounting strain. The familiar but alarming statistics form the case to policymakers to invest in adaptation and join the Belém plan. More than 540,000 people now die annually from extreme heat, a 63% rise since the 1990s. Between 3.3 and 3.6 billion people live in regions highly vulnerable to climate change. One in twelve of the world’s 200,000 hospitals face the risk of total shutdown due to extreme weather events under high-emissions scenarios, with more than 70% of at-risk facilities located in low- and middle-income countries. Hospitals and health facilities are also 41% more likely to suffer damage from extreme weather events than in 1990. “Climate change is an unavoidable reality that challenges public health and adds pressure on already overwhelmed systems,” Padilha said, calling policies to protect the health sector one of the “most strategic decisions of the 21st century.” “Protecting lives, reducing inequalities, and bolstering the resilience of health systems are no longer just goals – they have become ethical and democratic imperatives,” he said. Mitigation left out of the main Belém text Brazil’s COP30 presidency chose the Amazon city of Belém in an effort to remind negotiators of the planet they are fighting to protect. While the report and Belém Health Action Plan focus on preparing health systems for climate impacts, the synthesis document draws a clear conclusion about what would most protect those systems: cutting emissions. “The evidence is clear: urgent and sustained mitigation across all sectors is the single most important health adaptation intervention,” states the executive summary. “There are profound physical, financial, and technological limits to adaptation, and health systems cannot remain resilient in a world of unchecked warming.” By reducing emissions, health systems would face less extreme weather events, fewer heat deaths, and smaller disease burdens, making adaptation needs less severe in the first place. That finding sits awkwardly with the Belém Health Action Plan itself, which contains no references to phasing out fossil fuels, the main driver of climate change. The fossil fuel omission came at the explicit instruction of the Brazilian COP30 presidency, according to people familiar with the negotiations, likely to open the door for more nations to sign on who will not commit to language on fossil fuel phase-out. What the report identifies as “the most effective measure” to protect health systems is excluded from the political Belém framework, which requires endorsement from governments, instead relegated to a supporting document with no political weight. “When COP30 delegates leave Belém, success will be measured by the courage governments have demonstrated to act on what is already known: that fossil fuels are destroying people’s health,” said Jeni Miller, health lead at the Global Climate and Health Alliance. “To ignore these realities would be to betray both science and humanity.” A $20 billion gap Adaptation needs for health systems estimated in the COP30 special report. Direct health sector adaptation interventions will require more than $22 billion annually by 2035, according to the report, approximately 7% of total adaptation financing needs in climate-vulnerable countries. Current health-specific climate finance reaching those countries totals around $500 to $700 million annually, representing 2% of adaptation funding and 0.5% of multilateral climate finance. Climate and health finance has grown considerably in recent years, rising tenfold from less than $1 billion in 2018 to $7.1 billion in commitments between 2018 and 2022, according to analysis published earlier this year by the Rockefeller Foundation, WHO and other partners. In 2022, this included $4.8 billion from bilateral donors, $600 million from multilateral development banks, $1.5 billion from multilateral health funds, and $130 million from philanthropies. The share of climate finance targeting the health sector increased from 1% in 2018 to 9% in 2022, the only sector apart from education to see an increase. Yet these flows remain far below estimated needs, and more than 90% of health adaptation funding from development banks arrives as loans rather than grants. “The evidence is clear that we have been too slow to act on climate change and we are now ill-equipped to cope with rising temperatures across the world,” said Alan Dangour, health and climate lead at the Wellcome Trust. The report identifies persistent gaps in readiness. Only 54% of national health adaptation plans assess risks to health facilities. Fewer than 30% of health adaptation studies consider income, 20% consider gender, and less than 1% include people with disabilities. More than 60% of National Adaptation Plans have no formal tracking or evaluation in place. “Extreme heat, air pollution and infectious disease all hit the most vulnerable hardest: children, pregnant people, older adults, outdoor workers, and communities with the fewest resources,” Dangour said. “At COP30 and beyond, governments must act on the science – cut emissions, invest in adaptation, and put health at the heart of climate action. Lives, economies, and our future depend on the solutions we deliver now.” Image Credits: COP30, COP30. How Intimate Partner Violence Affects Children 14/11/2025 Disha Shetty Children’s health suffers in households where their mothers are abused. Noma Bolani has a clear memory of her abusive father stopping the car in the middle of the highway in Durban, South Africa and asking her mother to get out. She was just six years old, but Bolani followed her mother out of the car, and together they sought help from a passing motorist. Bolani is now 38, and has anxiety stemming from early childhood experiences related to growing up with an abusive father and witnessing her mother being at the receiving end of emotional and financial violence. Ayesha*, 34, from New Delhi, India, grew up watching her mother being subjected to physical, emotional and financial violence from her father. He would sometimes also resort to silent treatment that would last weeks, refuse to pay school fees for Ayesha and her sister and resort to physical violence using belts, shoes and, at times, utensils. Ayesha suffers from Polycystic Ovary Disease (PCOD) that affects the regularity of her periods and causes hormonal changes. Her doctor believes the stress she was subjected to as a child played a significant role in worsening her PCOD. Like Bolani, Ayesha also carries mental health scars from watching violence directed at her mother. When mothers are at the receiving end of violence, it can make their children physically ill, according to a growing body of research. Impact on children’s health Health data from 37 countries in sub-Saharan Africa found that children under the age of five whose mothers experienced intimate partner violence (IPV) were more likely to develop diarrhoeal disease and symptoms of acute respiratory infections, according to a study published in The Lancet last year. It called for tailored interventions to address childhood morbidity and mortality attributed to IPV in “priority countries” – Burkina Faso, Burundi, Chad, Comoros, Gabon, Liberia, Nigeria, Sierra Leone, South Africa, and Uganda. “The most important thing is actually the cumulative effect,” said Abel Dadi, lead author and a social epidemiologist at the Menzies School of Health Research at the Charles Darwin University in Australia. His study looked at exposure to three kinds of violence – physical, sexual and emotional. “When they come together, their effect increases,” he said. Dadi’s team also found a strong link between IPV and stunting in Burundi, and IPV and children being underweight in Burkina Faso, although the results were not consistent across all countries. What is not yet clear is the exact pathway of how IPV directed towards the mother affects a child’s physical health. A mother and newborn at a health center in the Patna district of Bihar, India. Babies’ health and well-being is deeply affected by their mother’s health. Pervasive violence The World Health Organization (WHO) recognizes that violence against women is a major public health issue. Globally, one third (27%) of women experience IPV in their lifetime, according to WHO figures. In sub-Saharan Africa, these rates are even higher, with 45·6% of women experiencing IPV in their lifetime. Young women aged 15 to 19 are the most affected by IPV. By the time they are 19 years old, almost a quarter of adolescent girls (24%) who have been in a relationship have already been physically, sexually, or psychologically abused by a partner, according to WHO data. However, while it is widely accepted that intimate partner violence affects a woman’s mental, physical and sexual health at risk, its impact on children has not received the same attention. But a child’s health and well-being are completely dependent on their mother during pregnancy, and heavily dependent in the early years, so a mother’s health and well-being directly affects her child’s health. The WHO, which developed a toolkit with UN Women to prevent violence against women in 2019, acknowledges that violence against women and against children often occurs in the same household. Psychiatrists like Bessel van der Kolk, who wrote ‘The Body Keeps the Score’, and Gabor Mate, author of ‘The Myth of Normal’, have also brought the lifelong impact of childhood trauma into the public domain, particularly of growing up with abusive parents. But IPV has long been seen as a criminal issue rather than a health issue. In India, for example, hospitals have only recently started to offer health workers training to see it as a public health problem. “I don’t think it is a well-understood field of work in terms of a response from the courts or from the state’s response to children’s rights,” said Julie Thekkudan, South Asia consultant at Equality Now, a global non-profit that advocates for women’s and girls’ rights. Each dot represents a different country in the region. There has been progress, with signs that IPV is reducing in some low- and middle-income countries due to progress in women’s empowerment. The reason women find it hard to leave abusive relationships, especially in the Global South, is that they have been socialized to tolerate violence, according to Thekkudan. In societies that favour sons and devalue daughters, girls are socialized into believing that their “purpose in life is to get married”, she explained. Staying in a marriage, even if it is abusive, and seen as part of “making sure that your family honor is maintained”, Thekkudan added. That, in addition to the fact that women don’t always have the financial ability to leave, makes it a harder choice. Dadi said that any intervention design on maternal health should consider intimate partner violence as well as the mental health of the mother. Currently, most of these kinds of interventions are concentrated in high-income countries, according to research. On average, countries that do better on gender equity indexes usually also experienc lower levels of violence against women, according to takeaways published in The Lancet. But a woman’s higher economic status can also make her vulnerable. One study from sub-Saharan Africa showed that women’s employment, especially if they were the sole earners or if they earned more than their male partner, was linked to a higher level of intimate partner violence. Any solution “has to be a multi-pronged, multi-level”, said Thekkudan. “I don’t think there is one solution that will change the entire system or the structure.” *Name changed to protect identity Image Credits: Photo by Alex Pasarelu on Unsplash, BMGF, World Bank. Brazil Wins Limited Backing for COP30 Climate-Health Plan, But Nations Commit No Finance 13/11/2025 Stefan Anderson Belém framework wins backing from two dozen nations, but health remains outside formal UN climate negotiations. Brazil launched a sweeping climate-health action plan on Thursday, named after the COP30 host city in the Amazon, winning initial endorsements from roughly two dozen countries for a voluntary framework calling on nations to strengthen disease surveillance, build climate-resilient infrastructure, and protect vulnerable populations from the health impacts of rising temperatures and extreme weather. The Belém Health Action Plan outlines 60 action items across surveillance systems, evidence-based policies, and health innovation to address the health risks facing 3.3 billion people globally affected by the climate crisis. “The climate crisis is one of the most significant health challenges of our time,” states the plan, developed by Brazil’s health ministry in consultation with the WHO. Countries that endorse the voluntary framework will report their progress through UN climate negotiations during the second Global Stocktake at COP33 in 2028. The World Health Organization calls climate change “the greatest single risk to humanity,” and the World Bank estimates it could cause up to 15.6 million deaths between 2026 and 2050, with health impacts costing $8.6 to $15.4 trillion by mid-century. Initial supporters include European Union states such as France and Spain, small island nations like Tuvalu, African countries from Congo to Zambia, and others including Canada, Japan, the United Kingdom and Malaysia. Brazil’s health minister Alexandre Padilha said the plan had received backing from more than 80 nations and institutions, though the vast majority comprises civil society organisations like the Global Climate and Health Alliance, global health actors including Medicines for Malaria Venture and Drugs for Neglected Diseases Initiative, and UN agencies such as UNFPA, UNICEF and UNITAID. “We expect to have more by the end of the day and the end of the COP,” Padilha said, adding the presidency would continue “trying to engage and mobilise” more countries. “There’s a very strong commitment from our government and ministers of health in this plan.” Delegates gather in the plenary hall of COP30 in Belem for the launch of the Brazil-WHO-led health-climate adaptation plan. The voluntary nature of the framework and broad support for the Alliance for Transformative Action on Climate and Health (ATACH) — a WHO-led initiative launched at COP26, which now counts 101 members — suggest endorsements will likely grow, but implementation remains uncertain. WHO will serve as the secretariat for the Belém plan, measuring outcomes through the ATACH framework. The sole explicit dissent Thursday came from Egypt, part of the Baku coalition of previous COP presidencies that helped draft the plan. Egypt’s health minister expressed willingness to join but voiced “concern about the reference to the inclusion of LGBTIQ+ individuals, as such patterns fall outside the nationally recognised policy frameworks in the cultural context of Egypt.” Other coalition members, the United Arab Emirates and Azerbaijan, expressed political will to continue discussions but stopped short of endorsement, instead noting they had “contributed” and “noted with interest” the framework’s goals. “We have to look at the impact of climate change, one of the main threats to public health in the world today,” Padilha said. “Scientific evidence has shown clearly that the climate crisis is first and foremost a crisis of public health throughout the world.” “The time of warnings has finished. Now we are living in a time of consequences,” he added. “The climate has already changed, so we have no alternative but to have public policies to adapt and face climate change.” No money from nations The voluntary adaptation framework was endorsed by around countries but faces billions in funding shortfalls. The launch came with no new financial commitments from endorsing nations. The sole funding announcement came from a coalition of philanthropies including the Gates Foundation, Wellcome Trust, and Rockefeller Foundation: a $300m one-time grant to support climate-health adaptation measures. That figure is dwarfed by estimates that low- and middle-income countries require at least $11 billion annually just for basic health adaptation covering only disease control for malaria, dengue, diarrheal diseases, heat-related mortality, and essential surveillance improvements, according to the UN Environment Programme. “Health systems, already stretched and underfunded, are struggling to cope with these growing pressures, and most are still unprepared for what is coming,” said Marina Romanello, executive director of the Lancet Countdown at University College London. “Existing finance falls short by billions. Without urgent investment, we will not be able to protect populations from escalating climate impacts.” The $11 billion annual UNEP pricetag excludes respiratory illnesses, malnutrition, mental health services, additional infectious disease programs, workers’ health protection, supply chain adaptation, and health system decarbonisation — most of what the Belém plan contains. The UNFCCC estimates global health adaptation will require $26.8 to 29.4 billion annually by 2050. Current health-specific climate finance reaching those countries totals perhaps $500 to $700 million annually, representing 2% of adaptation funding and 0.5% of multilateral climate finance. “With regards to finance, that reality is that we have a deficit that is quite colossal,” said Carlos Lopes, Special Envoy for Africa to the COP30 Presidency. A WHO survey of National Health Adaptation Plans found all included climate-health risks. But just 28 nations worldwide have completed such plans. As temperatures continue rising and extreme weather events intensify, pressure mounts for health system adaptation at a moment when global health financing faces unprecedented strain. Overall development assistance for health dropped 21% from nearly $50 billion in 2024 to $39 billion in 2025, driven largely by US withdrawal from global health programs. The WHO itself faces budget shortfalls of 15-20%. Climate-health financing has grown from less than $1 billion globally in 2018 to $7.1 billion in 2022, the only aid sector to grow in that time apart from education, according to Rockefeller Foundation analysis. But substantial portions arrive as loans: 24% of bilateral climate-health funding and more than 90% from the Asian Development Bank and Inter-American Development Bank. Many developing countries now spend more on servicing debt than on healthcare, with low-income countries spending roughly 300 times less per capita on health than wealthy nations. That finance shortfall impacts their ability to implement adaptation plans like the Belem Framework: A 2021 WHO survey found that while half of the countries reported having national health-climate strategies, less than a quarter achieved high implementation levels. Insufficient financing was identified as the key barrier by 70% of responding countries. Health’s struggles mirror wider climate adaptation finance gaps. At COP26 in 2021, developed countries pledged to triple overall adaptation finance from 2019 levels to at least $120 billion per year by 2025. Actual flows across all sectors totalled $26 billion in 2023. Money will determine whether Belém becomes an implemented plan or another symbolic declaration. Without tens of billions in annual funding, it will likely follow previous COP health commitments that failed to translate rhetoric into action. “The Belém Health Action Plan gives us the blueprint,” said Simon Stiell, executive secretary of the UN Framework Convention on Climate Change. “What we need now is sustained, coordinated and well-financed action to turn its promises into protection for all.” What’s the plan? Launch event for the Belem Health Action Plan at COP30. The Belém plan functions as a framework of best practice recommendations for adapting health systems to the climate crisis, containing no legally binding requirements or targets. Instead, the document outlines recommendations organized around surveillance systems, policy interventions, and infrastructure overhauls that officials say are essential to protecting billions from climate-driven health crises. The one specific requirement: Countries that endorse it will report progress through the Paris Agreement’s Global Stocktake by COP33 in 2028, with no enforcement mechanisms or compliance requirements. “For decades, WHO has been calling for action to adapt health systems and build resilience to climate change,” said Tedros Adhanom Ghebreyesus, WHO director-general. “The Belém health action plan is how we can do that.” “Health systems themselves are affected by climate change, compromising their ability to deliver life-saving care when people need it most,” he said. “There can be no healthy people on a sick planet.” The first focus: building the capacity to see threats coming. The framework calls for climate-informed health monitoring that links meteorological agencies with health institutions, using predictive modelling to trigger early warnings before heat waves, floods, or disease outbreaks overwhelm communities. Surveillance should also track which populations face the greatest risks, data officials say is often missing. The second area addresses policy interventions to protect communities, including clean energy and sustainable transport, heat protection for workers, mental health support woven into climate response, and targeted measures for Indigenous peoples and persons with disabilities. ”For many countries, adaptation is a question of survival in the short run. If you don’t adapt, it threatens the coverage of health services of patients and professionals who are already facing adverse conditions,” Padhila said. “If we don’t adapt, we are going to increase inequality. In short, if you don’t adapt, we will kill people.” Water & power “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. Finance will determine whether the Belém framework’s most ambitious element, climate-resilient infrastructure, can be delivered. The plan envisions health facilities built to withstand climate shocks, renewable energy powering clinics, telehealth platforms extending care, and strategic stockpiles of temperature-stable medicines and vaccines. It calls for “integrated methodologies linking environmental, meteorological, social, climate and health monitoring data” with real-time surveillance and digital technologies as “structural components.” The problem: roughly 100,000 health facilities in sub-Saharan Africa lack reliable electricity, affecting nearly a billion people worldwide. Up to 70% of medical equipment in developing countries sits unused due to power failures. Cold chains for vaccines, digital surveillance systems, early warning platforms, and telehealth services all depend on reliable power that serving populations don’t have. Closing the healthcare electrification gap by 2030 would cost $4.9 billion, about $5 per person affected over six years. That’s less than one year of current global climate-health spending. “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. “It is very important we have the policies… working on the value chains of electricity to make sure that our babies, who are getting born without electricity,” have access to care. Water and sanitation infrastructure are equally critical, she noted. “If we bring water, we bring sanitation. There is already a disease that we will put away. We can tell our boys and girls to wash their hands, but how could they do it if there is no water at the school?” Just three nations have completed all four ATACH assessments as of 2025. The Belém plan’s success will depend not just on building infrastructure, but on countries’ ability to track and report progress. WHO will measure implementation through ATACH, its Alliance for Transformative Action on Climate and Health, which already requires members to complete vulnerability studies, adaptation plans, emissions inventories, and decarbonization roadmaps. The record so far suggests those demands exceed many countries’ capacity. Four years after ATACH’s launch in 2021, only three countries—France, Japan, and the UK—have completed all four assessments. Across 88 countries with available data, roughly 35-40% completed vulnerability assessments and 30% finished adaptation plans. In Africa, fewer than 10 of 29 ATACH members have completed vulnerability assessments. The Belém plan now adds reporting requirements on top of those existing gaps: tracking mental health impacts, monitoring workers’ heat exposure, establishing community resilience programmes, and climate-proofing supply chains, all by 2028. That creates an impossible bind. France, Japan, and the UK have the technical capacity and resources to meet these demands. Many other countries lack not only the expertise for complex reporting systems, but the basic infrastructure, electricity and water, that the plan assumes as a foundation. “Finance is still the bottleneck for us,” Princess Djigma said. Fossil fuel phase-out excluded Delegates arrive for the opening day of COP30 on the edge of the Brazilian Amazon. Notably absent from the plan is any reference to phasing out fossil fuels, the main driver of climate change and the resulting heat, extreme weather and air pollution killing approximately 8m people annually from respiratory and cardiovascular diseases. The omission came at the explicit instruction of the Brazilian COP30 presidency, according to people familiar with the negotiations. The exclusion comes as the International Energy Agency warned Wednesday that global oil and gas demand will rise for the next 25 years if countries do not change course. Until this year, all of the Paris-based body’s modelling assumed fossil fuel consumption would peak this decade. “Climate change is declining — and declining rapidly — in the international energy policy agenda,” said Fatih Birol, the IEA’s executive director. “And this is happening while 2024 was the hottest year in history.” Fifteen countries allocated more resources to fossil fuel net subsidies than their entire national health budgets. Birol’s findings align with the Lancet Countdown report published ahead of the summit, which found the 100 largest oil and gas companies have production strategies that put them on track to exceed their share of production consistent with 1.5 °C of heating by 189% in 2040, up from 183% in March 2024. Private bank lending to fossil fuel activities surged 29% to $611 billion in 2024, exceeding green sector lending by 15%. Some 73 of 87 countries reviewed provided net explicit fossil fuel subsidies in 2023, allocating nearly $1 trillion in direct support. Including indirect subsidies, that figure rises to over $7tn, according to the International Monetary Fund — more than governments spend annually on education and about two-thirds of what they spend on healthcare. The declining political attention extends to international engagement: Mentions of health and climate change by governments in their annual UN General Assembly statements declined from 62% in 2021 to 30% in 2024, according to the Lancet Countdown. “Record deaths from climate-driven wildfires in 2023 show that there’s no adaptation without mitigation,” said Nina Renshaw, head of health at the Clean Air Fund. “Ministries of Health and Finance won’t be able to bail hospitals and clinics out of the climate emergency if governments don’t stop the emissions which are already causing unprecedented harm.” ‘More than dialogue’ Delegates convened for the first-ever Health Day at a UN climate summit in Dubai. The Belém plan follows a pattern established at recent climate summits: the COP28 Dubai Health Declaration signed by 143 countries, the Baku Coalition for Climate and Health launched last year, and efforts stretching back to Glasgow in 2021. Like those efforts, Belém is a non-binding, voluntary process taking place outside formal UN negotiations. Criticisms of the outcomes of Dubai and Baku describe their outcomes as symbolic gestures that generate attention but fail to secure funding, sustained commitment, or implementation. Officials on Thursday repeatedly stressed the need to break the holding pattern. “This gathering must be more than dialogue,” said Jarbas Barbosa, director of the Pan American Health Organization. “It must galvanise collective action and inspire new policies dedicated to protecting everyone’s health from the worsening effects of climate change.” “The climatic crisis is fundamentally a health crisis,” Barbosa said. “We are not talking any more about distant or possible threats. Climate change is a present and growing reality.” Whether the Belém framework can overcome the obstacles that have stymied previous declarations — insufficient financing, limited technical capacity, competing priorities — remains uncertain. But Padilha argued the world has no choice but to try. “We are faced with a dilemma: we either continue to speak and speak and talk, or we can walk the walk and make the political commitment to do so,” he said. “We cannot accept the erosion of multilateralism in global health. Those who deny multilateralism are surrounding us. We will not listen to them.” Image Credits: COP30, COP30, COP30, COP30, COP30, COP30, WHO . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Global Fund Seeks $14 Billion at Replenishment Summit – With Progress Against HIV, TB and Malaria at Risk 20/11/2025 Kerry Cullinan Deborah and her 10-month-old daughter Catherine at the Baylor College of Medicine Children’s Foundation in Lilongwe, Malawi. Deborah is living with HIV and Catherine is on preventive treatment. JOHANNESBURG – The Global Fund (GF) has only raised $4 billion of its $18 billion budget for the next three years – so much is riding on its Replenishment Summit in Johannesburg on Friday (21 November) as it seeks the balance to advance progress against HIV, tuberculosis (TB) and malaria. The United States has been the largest donor to the Global Fund, contributing around one-third of its budget – but whether it will still contribute generously is an open question, given the Trump administration’s “America First” focus. “We have been in almost constant dialogue with the US since the beginning of the year, and we have not received any stop-work order or any sort of notification that the funding will be stopped,” Francoise Vanni, the Fund’s external relations and communications director, told a media briefing in Johannesburg on Thursday. “We are confident that they will pledge to the Replenishment tomorrow,” added Vanni, pointing out that the US and the GF are working closely to roll out the long-acting HIV prevention medicine, lenacapavir, in several African countries. South Africa and the United Kingdom (UK) are co-hosting the Replenishment, but that did not prevent the UK from cutting its contribution by 15%. The Fund provides 73% of all international financing for TB, 60% for malaria and 24% for HIV. Médecins Sans Frontières (MSF) has described initial pledges as “deeply concerning”. “Germany and the United Kingdom – the only major traditional donors to pledge so far – have both decreased their commitments compared to the last cycle. Specifically, Germany has pledged €1 billion instead of €1.3 billion and the UK has pledged £850 million instead of £1 billion,” MSF noted on Thursday. “No donor has increased their pledge when considering inflation. If other major donors follow Germany and the UK’s examples, the results would be catastrophic for people impacted by TB, HIV, and malaria worldwide,” MSF said. “Failure to meet this [$14 billion] goal would risk catastrophic cuts to essential services, threaten the resurgence of HIV, TB, and malaria – the world’s top three deadliest infectious diseases – and put the financial burden of health care onto the world’s most vulnerable patients.” Members of a spray team prepare their equipment before spraying homes with insecticide to protect families from malaria in Kaukira, Honduras. Saving 70 million lives The GF is the world’s largest funder of global health, and it has saved an estimated 70 million lives since its establishment 22 years ago, according to its Results Report 2025. Around $103 billion has also been saved in reduced hospitalisations, freeing countries’ health systems to address other diseases and other health needs, Vanni noted. While it works in over 100 countries, its effect has been felt primarily in Africa, where 73% of its budget has been spent. In 15 priority countries in sub-Saharan Africa, life expectancy has increased from 49 years old in 2001 to 61 in 2021 – mostly thanks to people with HIV getting access to antiretroviral medicine. In Zambia, for example, life expectancy has increased by 19 years from 43 to 58 years. Since the GF was launched in 2002, AIDS-related deaths have been reduced by almost three-quarters in the countries where the Global Fund operates, and new infections have been reduced by 62%. Without these interventions, AIDS deaths would have increased by 90% and new HIV infections by 75% over the same period. In 2024 alone, Fund-supported TB programmes treated 7.4 million people with TB. Between 2002 and 2023, GF efforts have reduced TB deaths by 40%. Without these, TB deaths would have increased by 134% and TB cases by 40% over the same period. Malaria deaths were reduced by 29% between 2002 and 2023, “even though the population in these countries has increased by 46%”, the Results Report notes. “Without malaria control measures, deaths would have increased by 94% over the same period.” Malaria ‘way off target’ Despite progress, HIV, TB and malaria remain the world’s deadliest infectious diseases. The $18 billion budget could save 23 million lives between 2027 and 2029, avert 400 million new infections and result in a 1:19 return on investment across the three diseases, according to Fund modelling. “Malaria is way off track, with 600,000 people a year dying,” admits Kate Kolaczinski, the Fund’s senior specialist on the disease. “Malaria is the leading cause of outpatient visits in sub-Saharan Africa,” she adds, with 263 million malaria cases in 2023. Between 2002 and 2023, malaria cases in countries supported by the Global Fund increased by 8% “Rising conflict, disruptions from extreme weather events and increasing resistance to antimalarial drugs and insecticides have complicated efforts to combat malaria in 2024,” according to the Results Report 2025. “The goal of ending [malaria] by 2030 looks daunting. Reductions in global health funding could undermine progress against malaria. A widening funding gap, combined with existing crises and an expected population growth in areas at high-risk of malaria, could threaten the lives of millions.” President Duma Boko of Botswana has urged countries to support the Replenishment, noting in an exclusive article for Health Policy Watch: “If the world retreats now, an additional 750,000 children in Africa could die by 2030, and our economies could lose $83 billion in GDP if funding is so low that all prevention interventions are halted.” HIV resurgence? “There’s a risk of HIV resurgence, especially now that we have funding challenges that we’re facing,” says the Fund’s HIV head, Izukanji Sikazwe, pointing out that 9.2 million people living with HIV still need access to treatment. “We are off target for HIV prevention. In 2024, there were 1.3 million new infections. We need a fourfold reduction to meet the 2025 target of 370,000.” Meanwhile, TB surged during the COVID-19 pandemic and but 2024 brought new progress against the disease. “Robust funding commitments in 2025 are absolutely critical to maintaining our momentum against TB and preventing a resurgence that could undo decades of hard-won progress,” according to the Results Report 2025. It describes an “exciting pipeline of innovative tools”, including new TB tests, better treatments and “at least five TB vaccines in phase III efficacy trials”. Private sector contributions While the bulk of the Fund’s budget comes from country contributions, the private sector also contributes – with the Gates Foundation being the biggest and most consistent private donor, contributing $3.91 billion since 2002. “The Global Fund will go down in history as one of humanity’s biggest achievements. It’s also one of the kindest things people have ever done for each other,” according to Gates Foundation chair Bill Gates. The Global Fund’s track record proves it is an excellent investment for our global health dollars. Its work is critical to achieving the goal of ending AIDS, TB and malaria, and making our world a more equitable place for people everywhere.” The Children’s Investment Fund Foundation (CIFF) has significantly increased its contribution recently, focusing on expanding access to lenacapavir by both supporting procurement and the development of generics. John Fairhurst, who heads the Fund’s private sector mobilisation, says that the sector has contributed over $5.3 billion in the past 20 years – often playing a “catalytic role” in innovation. Unlike countries, which give unrestricted funds, private donors can earmark their contributions. Image Credits: Tommy Trenchard/ Global Fund, Global Fund. World Falls Far Short of Methane Cut Targets Halfway to 2030 Deadline 18/11/2025 Stefan Anderson Infrared camera reveals escaped methane emissions from oil rig. Methane leaks from oil and gas make a major contribution to global warming. First UN assessment since the 2021 Glasgow pledge shows methane cuts falling far short of targets needed to meet climate goals. Accelerated action could yield $330 billion in annual benefits by 2030 through improved health and reduced crop losses. Four years after more than 100 countries pledged to slash methane emissions 30% by the end of the decade, a UN assessment has found nations are on track to deliver barely a quarter of that target. The Global Methane Status Report, released Monday at COP30 in the Brazilian Amazon city of Belém, found that current national commitments would cut global methane emissions by just 8% below 2020 levels by 2030. Despite the lack of progress, the 30% target remains technically achievable with increased investment and policy-driven reform, the report found, adding it could yield some $330 billion in benefits to health and cost production, nearly double the cost of investment in methane emissions mitigation. While methane emissions are not a part of formal negotiations in the UN Framework Convention on Climate Change (UNFCC)C, it is the world’s second largest contributor to global warming, after CO2, with a global warming potential 86 times greater. A precursor to ground-level ozone formation, methane is a contributor to air pollution-related deaths as well as reduced crop yields. With an atmospheric lifespan of only about 12 years, reducing methane emissions can yield enormous co-benefits for health as well as reducing the pace of climate change. Collective, non-binding target The Global Methane Status Report produced by the UN Environment Programme is the first comprehensive stocktake of global progress on methane emissions since reduction targets were announced at COP26. The assessment comes as global methane concentrations have reached the highest levels in at least 800,000 years, more than 2.6 times pre-industrial levels, with the gas responsible for roughly one-third of present-day global warming. The new report compiled by the UN Environment Programme is the first comprehensive stocktake since the Global Methane Pledge was launched at the UN climate summit in Glasgow, COP26. The Global Methane Pledge, a non-binding political commitment signed by 159 countries, set a collective global reduction target rather than assigning specific cuts to individual countries or sectors, leaving nations to develop their own strategies and action plans. “Slow climate action means that the multi-decade average of global temperatures will exceed 1.5°C within the next decade,” Ruth do Cutto, deputy climate change chief at UNEP said at a press briefing launching the report. “We must make sure that this overshoot is as short and as low in temperature as possible, and we cannot do that without curbing emissions of methane, which is responsible for one-third of today’s global warming.” Methane’s potency as a greenhouse gas, combined with its relatively short atmospheric lifespan, makes cutting emissions one of the fastest ways to slow near-term temperature rise, often called an environmental “hand brake” by climate experts. “Lack of time is our biggest challenge,” said COP30 President Ana Toni, noting that slashing methane emissions “delivers the fastest results” for slowing warming. Full deployment of what the report calls “maximum technically feasible reductions” could still cut emissions 32% below 2020 levels by 2030, even surpassing the pledge target. These measures would cost an estimated $127 billion annually but deliver benefits valued at $330 billion per year by 2030, including preventing more than 180,000 premature deaths, avoiding 19 million tonnes of crop losses, and reducing global temperatures by 0.2°C by mid-century. “We’re on a highway to hell with the foot on the gas pedal,” Martina Otto, head of the Climate and Clean Air Coalition Secretariat, which produced the report with the UN Environment Programme, said at the launch event in Belém. “If we are heading towards the wall, you don’t just pull the handbrake a little bit. You pull it forcefully and fast. And I think that’s where we are right now,” Otto said. Slow momentum, US wildcard The 159 countries now signed to the pledge, up from just over 100 at launch, represent nearly half of global methane emissions. However, three of the world’s top five emitters remain outside the agreement: China, the largest overall source, India and Russia. China’s participation in a methane summit co-hosted with Brazil and the United Kingdom on the sidelines of COP30 marked a notable diplomatic shift, though Beijing has yet to sign the global methane pledge. Since the pledge’s launch, projected 2030 emissions have improved modestly. Some 127 countries, representing 65% of Paris Agreement parties, now include methane mitigation measures in their latest Nationally Determined Contributions, a 38% increase from pre-2020 levels. New waste management regulations in Europe and North America, combined with slower-than-expected growth in natural gas markets between 2020 and 2024, have lowered forecast emission levels by 14 million tonnes compared with 2021 projections, UNEP found. The emissions decrease documented in the report is relative to levels projected in 2021, not a net reduction. While methane emissions were on track to increase by 13% by 2030, that would fall to 5% if nations follow through on pledged cuts. Overall, global methane emissions continue to rise, reaching approximately 352 million tonnes in 2020 and projected to hit 369 million tonnes by 2030 under current legislation. “If countries fully implement their existing methane plans submitted as of June 2025, global emissions could fall by about 8% this decade,” Otto said. “That would constitute the largest and most sustained decline in methane emissions ever recorded. So it works, but it doesn’t work fast enough.” The report’s modelling does not account for the United States reversing its methane commitments. While the US was once a leading nation in advocating methane emissions cuts and a core author of the 2021 pledge in Glasgow, the Trump administration has rolled back domestic methane policies and pressured the European Union to delay implementation of new methane emissions regulations that would increase reporting transparency. Some US states, including California, have maintained stricter methane reporting requirements. Agriculture, energy and waste lead methane-emitting sectors Global anthropogenic methane emissions in the current policies scenario, 1990–2050, million tonnes per year The UNEP report found that agriculture accounts for 42% of global methane emissions, the energy sector 38%, and waste 20%. The G20 countries plus the European Union and several other developed nations are responsible for 65% of total emissions, with China taking the top spot. The energy sector offers the largest mitigation opportunity, UNEP said, with 72% of technically feasible reductions by 2030 concentrated in oil, gas and coal operations. More than 80% of the total reduction potential across all sectors can be achieved at costs below $36 per tonne of CO2 equivalent, with many fossil fuel measures actually profitable because they capture gas that can be sold rather than vented or flared. Inger Andersen, executive director of UNEP, said “reducing methane emissions is one of the most immediate and effective steps we can take to slow the climate crisis while protecting human health.” Chloe Brimicombe, a climate scientist at the Royal Meteorological Society, linked methane emissions to more frequent and intense heatwaves, which kill nearly 600,000 people annually. “Heat puts immense stress on the body, particularly for children, older people and those with chronic illness,” she said, describing methane cuts as a “fast and effective way to help protect communities from heat-related illness and deaths.” “Reducing methane decreases the precursors of ground-level ozone, reducing cardiovascular and respiratory disease immediately,” said Courtney Howard, an emergency physician and chair of the Global Climate and Health Alliance. “Cutting methane is a win-win for health and health systems now and into the future.” ‘On the radar’ Global anthropogenic methane emissions under different scenarios, 1990–2050, million tonnes per year. Regional studies “continue to reveal significant underreporting of methane emissions, particularly within the fossil fuel sector,” the report found. Dan Jørgensen, European Commissioner for Energy and Housing, said nearly 90% of satellite-detected emission events still go unaddressed by governments and fossil-fuel companies. Liz Thompson, climate ambassador of Barbados, called reining in these oversights a “matter of survival” for small island nations. “We need oil and gas companies to recognise the importance of cutting methane emissions by stopping flaring and leaks,” she said. “Over the next year, we must advance discussions so that COP31 can perhaps present a concrete proposal to initiate efforts that will lead to a legally binding agreement.” Current methane-focused investment has reached $13.7 billion annually, up 18% in recent years but far below the $127 billion needed by 2030. Measures in the fossil fuel sector could be deployed at little to no net cost, with bills for the energy sector overall representing just 2 to 4% of the industry’s 2023 income, according to the report. “It shows that methane has made it onto the radar and that we’ve gained momentum, that cost-effective solutions exist today, essentially waiting to be brought to scale, and that the benefits are enormous,” Otto said. “We can do it, but we have to act much faster.” China’s participation in COP30 methane summit marks a shift The report launch coincided with a “methane summit’’ co-hosted by Brazil, China and the United Kingdom on the sidelines of COP30. The summit launched a “Super Pollutant Country Action Accelerator” providing $25 million in initial funding for seven developing countries to establish dedicated national methane units, modelled on the successful Montreal Protocol ozone programmes. China’s participation marked a significant diplomatic development, as Beijing co-hosted the event despite not being a signatory to the Global Methane Pledge. The country is the world’s largest methane emitter, primarily from its massive coal mining sector. “The summit not only underscores the critical role of controlling methane and other non-CO2 greenhouse gas emissions in the global response to climate change, but also encourages all parties to share the policies and actions they have taken in the emission reduction process,” Huang Runqiu, China’s environment chief, said at the summit. “Climate change is a global challenge, and addressing it requires concerted efforts from the entire world.” The UK also led a statement signed by Canada, France, Germany, Japan, Kazakhstan and Norway committing to drastically reduce methane emissions in the fossil fuel sector, including ending routine flaring and venting by 2030 and developing a “near-zero methane intensity marketplace” by 2026 to use trade measures to reward low-emission producers. “The global methane pledge has had an impact. It supported the reshaping of national priorities,” Otto said. However, she noted the report had to exclude the latest round of national climate plans submitted after June 2025 from its modelling. “Obviously, we have seen new coming in, but we had to do the modelling at one point, and so that became our cut-off.” Beyond 2030, the report warned that technical fixes alone will prove insufficient. Meeting 1.5C or 2C warming targets will require combining methane controls with broader energy decarbonisation and demand-side measures, including dietary shifts and reduced food waste, potentially cutting emissions 53% below 2020 levels by 2050. “We can still make it,” Otto said. “But it will take a whole lot of additional effort. It’s not possible if we do it half-heartedly.” With five years remaining until the 2030 target, “the choices made in the next five years will determine whether the world seizes this opportunity, unlocking cleaner air, stronger economies, and a safer climate for generations to come,” UNEP concluded. Image Credits: Clean Air Task Force . Former DOGE Official Driving US Bilateral Health Agreements With African Countries 17/11/2025 Kerry Cullinan US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenyan Treasury and health officials. The United States government is moving rapidly to secure Memorandums of Understanding (MOU) with African countries that offer limited health aid for five years in exchange for 25 years’ access to countries’ data about “pathogens with epidemic potential”. Some commentators have described the terms of the bilateral MOUs as “extractive” as they fail to offer African countries access to the health products that might be developed from the pathogen material that they share. The process is being driven by Brad Smith, formerly one of the leaders of Elon Musk’s Department of Government Efficiency (DOGE), who was responsible for implementing deep cuts to the US Health and Human Services (HHS) department. Smith is now a global health advisor in the US State Department, overseeing the reorganisation of the US President’s Emergency Plan for AIDS Relief (PEPFAR) and health grants from the now defunct US Agency for International Development (USAID). He was part of the US delegation that met Kenyan health and finance officials last week to discuss its MOU. So too was Bethany Kozma, a former USAID official during the first Trump administration and a fervent anti-abortion campaigner. She is currently chief advisor for policy and strategy in the HHS Global Affairs Office. Bethany Kozma, anti-abortion campaigner and chief advisor for policy and strategy in the HHS Global Affairs Office, also attended the meeting with Kenya. Dr Chris Kiptoo, Kenyan Treasury’s Principal Secretary, reported after last week’s meeting that “both countries are finalising a bilateral agreement that aligns Kenya’s health priorities with the United States’ global health objectives, strengthening a partnership that saves lives and builds a more resilient health system for our nation”. Meanwhile, Rwandan Health Minister Dr Sabin Nsanzimana met a US delegation headed by Dr Mamadi Yilla, US State Department deputy assistant secretary for health diplomacy, last week to discuss a new MOU. Rwandan Health Minister Dr Sabin Nsanzimana and Dr Mamadi Yilla, US deputy assistant secretary for global health diplomacy and other officials. Smith also led the US delegation to Zambia on Monday (17 November), where he met Zambia’s Health Minister, Dr Elijah Muchima, and Finance Minister Situmbeko Musokotwane. The meeting aimed to “chart a new course for US health assistance to Zambia”, according to the US Embassy in Zambia. “The new approach envisions both governments committing to funding levels and health outcome performance objectives in order to accelerate the transition from an aid-dependent health sector to a Zambian government-led health system that is able to sustainably meet the health needs of the Zambian people,” according to the US media release. US official Brad Smith and Zambian Finance Minister Situmbeko Musokotwane. Extensive access to data The MOUs include clauses that would give the US extensive access to country health databases and contain punitive measures for countries that fail to provide this access or pathogen information, including unspecified “changes in the planned assistance” or total discontinuation of aid. Conversely, those that meet targets may get unspecified rewards. While the agreements contain a list of targets (“outcome metrics) for reducing HIV, TB, malaria, maternal and under-five mortality, and increasing measles vaccinations, details about how these will be achieved are scanty. In contrast to the health services section, the “surveillance and outbreak response” section is far more detailed, with budget allocations and staff numbers. For instance, Zambia is expected to employ “1,723 field epidemiologists” in 2026 at its own expense to meet its outbreak surveillance and pathogen-sharing requirements, according to a draft seen by Health Policy Watch. The US also notes in the draft Zambian MOU that it is making a $50 million cut to its previous commitment of $120 million in funding for antiretroviral (ARV) medicine and HIV tests due to “historic theft”. This relates to a 2021 scandal where it emerged that ARVs donated to Zambia were being sold in pharmacies. Countries need the capacity to detect disease outbreaks within seven days and report to the US on these within a day of an outbreak being detected, according to the MOUs. Twenty-five years’ access for five-year grants Countries also have to commit to signing a 25-year “specimen sharing agreement”, although the MOUs only cover a five-year grant period. This agreement will cover “sharing physical specimens and related data, including genetic sequence data, of detected pathogens with epidemic potential for either country within five days of detection”. However, an annex that is supposed to set out the “elements” of the agreement is blank. Bizarrely, the MOUs also want governments to commit to a 25-year “data sharing arrangement” for “exchanging data on the long-term performance of this MOU and for accountability to the United States Congress for appropriated funds”. However, the country grants will only run from 1 April 2026 until 2030. Author Emily Bass published a template for this data-sharing arrangement over the weekend, saying that it “reveals the unprecedentedly extractive nature of these ongoing negotiations”. The US wants access to a range of data, including electronic medical records, health management and information systems, and outbreak response and surveillance data systems. “This agreement affords the US at-will visibility into digital systems, including those, like electronic medical records, that include personal identifiable information,” Bass notes. In the audit section, the MOUs stress that countries need to provide the US with “any data access or information needed to monitor compliance with applicable legal requirements, including to confirm no US government funding is being used for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions”. The MOU concludes by noting that it is not a legally binding document but “a record of the intentions of the parties”. Bypassing WHO? Member states started to negotiate a pathogen access and benefit-sharing system at the WHO headquarters in Geneva recently. By placing itself at the centre of rapid information-sharing about dangerous pathogens, the US appears to be attempting to usurp the World Health Organization (WHO). WHO member states are currently negotiating a Pathogen Access and Benefit Sharing (PABS) system that unite countries, pharmaceutical companies and non-profits in a single process aimed at speedily sharing information and developing counter-measures for pathogens that can cause pandemics. The US and Argentina are the only countries that have opted out of these negotiations. However, if the US is the gatekeeper of pathogen information via these MOUs, this likely to fracture and slow down the global response to pandemics. In addition, US companies could also get the first shot at developing vaccines, therapeutics and diagnostics for these pathogens. Aggrey Aluso of Resilience Action Network Africa (RANA) warned that while governments “should explore deals that could benefit the lives of their people and their economy, such deals should not be extractive”. “Global health security cannot be built on coercive conditionalities,” Aluso told Health Policy Watch. “True preparedness demands equity, respects data sovereignty, and is grounded in solidarity — not transactions that deepen inequities and silence the voices of those most affected. The current version of the proposed MOUs need an inclusive, equity-centred approach.” Health Systems Are Unprepared for The Climate Crisis 14/11/2025 Stefan Anderson The synthesis report follows the launch of the Belém Health Action Plan at COP30, a voluntary best practice framework to assist governments in adapting their health systems for climate change. Nations worldwide must finance and implement climate adaptation measures for health systems or risk losing millions of lives as extreme weather, rising temperatures, and intensifying heat threaten healthcare access for nearly half the global population, according to a report published Friday by the World Health Organization and Brazil. The special report, released at the COP30 summit in Belém, follows Thursday’s launch of the Belém Health Action Plan, which won backing from roughly two dozen countries but secured no financial commitments from governments. The only funding to support the plan came from philanthropies: a $300 million one-time grant. The report estimates health system adaptation needs at $22 billion per year by 2035. “The climate crisis is a health crisis – not in the distant future, but here and now,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This special report provides evidence on the impact of climate change on individuals and health systems, and real-world examples of what countries can do – and are doing – to protect health and strengthen health systems.” The past decade has been the hottest on record, with global temperatures exceeding 1.5°C above pre-industrial levels for the first time in 2024. Updated Climate Tracker projections published at the UN climate summit on Wednesday show the world on track for 2.5°C of warming, while the UN Environment Programme projected last week that a business-as-usual scenario has the world heading for 2.8°C. Every fraction of a degree endangers millions. “Many health systems are fragile, lacking climate-trained personnel, resilient infrastructure and adequate surveillance,” said Simon Stiell, executive secretary of the UN Framework Convention on Climate Change. “Watching super typhoons and flash floods rip through hospitals and local health clinics is heartbreaking, but lamenting is not a strategy. We need real solutions.” Simon Still, executive secretary of the UNFCCC, addresses COP30’s opening plenary. “The real challenges people face, such as extreme heat, air pollution, infectious diseases, mental health and food insecurity – humanity can only win this global climate fight if we connect stronger climate actions to people’s top priorities in their daily lives, and there are few higher priorities than our health,” Stiell said. The report does not present new evidence, functioning instead as a synthesis of the best available science and data on the risks posed to unprepared health systems by climate change, drawing on academic literature, government and UN reports, and real-world case studies. “Recent tragedies show that now is the time to implement policies and actions that address the impacts of climate change on health,” said Alexandre Padilha, Brazil’s health minister. “The Belém Health Action Plan and this report offer countries the tools they need to turn scientific evidence into concrete action.” As storms batter coastlines, floods displace communities, and droughts fuel conflict and hunger, the report paints a picture of health systems under mounting strain. The familiar but alarming statistics form the case to policymakers to invest in adaptation and join the Belém plan. More than 540,000 people now die annually from extreme heat, a 63% rise since the 1990s. Between 3.3 and 3.6 billion people live in regions highly vulnerable to climate change. One in twelve of the world’s 200,000 hospitals face the risk of total shutdown due to extreme weather events under high-emissions scenarios, with more than 70% of at-risk facilities located in low- and middle-income countries. Hospitals and health facilities are also 41% more likely to suffer damage from extreme weather events than in 1990. “Climate change is an unavoidable reality that challenges public health and adds pressure on already overwhelmed systems,” Padilha said, calling policies to protect the health sector one of the “most strategic decisions of the 21st century.” “Protecting lives, reducing inequalities, and bolstering the resilience of health systems are no longer just goals – they have become ethical and democratic imperatives,” he said. Mitigation left out of the main Belém text Brazil’s COP30 presidency chose the Amazon city of Belém in an effort to remind negotiators of the planet they are fighting to protect. While the report and Belém Health Action Plan focus on preparing health systems for climate impacts, the synthesis document draws a clear conclusion about what would most protect those systems: cutting emissions. “The evidence is clear: urgent and sustained mitigation across all sectors is the single most important health adaptation intervention,” states the executive summary. “There are profound physical, financial, and technological limits to adaptation, and health systems cannot remain resilient in a world of unchecked warming.” By reducing emissions, health systems would face less extreme weather events, fewer heat deaths, and smaller disease burdens, making adaptation needs less severe in the first place. That finding sits awkwardly with the Belém Health Action Plan itself, which contains no references to phasing out fossil fuels, the main driver of climate change. The fossil fuel omission came at the explicit instruction of the Brazilian COP30 presidency, according to people familiar with the negotiations, likely to open the door for more nations to sign on who will not commit to language on fossil fuel phase-out. What the report identifies as “the most effective measure” to protect health systems is excluded from the political Belém framework, which requires endorsement from governments, instead relegated to a supporting document with no political weight. “When COP30 delegates leave Belém, success will be measured by the courage governments have demonstrated to act on what is already known: that fossil fuels are destroying people’s health,” said Jeni Miller, health lead at the Global Climate and Health Alliance. “To ignore these realities would be to betray both science and humanity.” A $20 billion gap Adaptation needs for health systems estimated in the COP30 special report. Direct health sector adaptation interventions will require more than $22 billion annually by 2035, according to the report, approximately 7% of total adaptation financing needs in climate-vulnerable countries. Current health-specific climate finance reaching those countries totals around $500 to $700 million annually, representing 2% of adaptation funding and 0.5% of multilateral climate finance. Climate and health finance has grown considerably in recent years, rising tenfold from less than $1 billion in 2018 to $7.1 billion in commitments between 2018 and 2022, according to analysis published earlier this year by the Rockefeller Foundation, WHO and other partners. In 2022, this included $4.8 billion from bilateral donors, $600 million from multilateral development banks, $1.5 billion from multilateral health funds, and $130 million from philanthropies. The share of climate finance targeting the health sector increased from 1% in 2018 to 9% in 2022, the only sector apart from education to see an increase. Yet these flows remain far below estimated needs, and more than 90% of health adaptation funding from development banks arrives as loans rather than grants. “The evidence is clear that we have been too slow to act on climate change and we are now ill-equipped to cope with rising temperatures across the world,” said Alan Dangour, health and climate lead at the Wellcome Trust. The report identifies persistent gaps in readiness. Only 54% of national health adaptation plans assess risks to health facilities. Fewer than 30% of health adaptation studies consider income, 20% consider gender, and less than 1% include people with disabilities. More than 60% of National Adaptation Plans have no formal tracking or evaluation in place. “Extreme heat, air pollution and infectious disease all hit the most vulnerable hardest: children, pregnant people, older adults, outdoor workers, and communities with the fewest resources,” Dangour said. “At COP30 and beyond, governments must act on the science – cut emissions, invest in adaptation, and put health at the heart of climate action. Lives, economies, and our future depend on the solutions we deliver now.” Image Credits: COP30, COP30. How Intimate Partner Violence Affects Children 14/11/2025 Disha Shetty Children’s health suffers in households where their mothers are abused. Noma Bolani has a clear memory of her abusive father stopping the car in the middle of the highway in Durban, South Africa and asking her mother to get out. She was just six years old, but Bolani followed her mother out of the car, and together they sought help from a passing motorist. Bolani is now 38, and has anxiety stemming from early childhood experiences related to growing up with an abusive father and witnessing her mother being at the receiving end of emotional and financial violence. Ayesha*, 34, from New Delhi, India, grew up watching her mother being subjected to physical, emotional and financial violence from her father. He would sometimes also resort to silent treatment that would last weeks, refuse to pay school fees for Ayesha and her sister and resort to physical violence using belts, shoes and, at times, utensils. Ayesha suffers from Polycystic Ovary Disease (PCOD) that affects the regularity of her periods and causes hormonal changes. Her doctor believes the stress she was subjected to as a child played a significant role in worsening her PCOD. Like Bolani, Ayesha also carries mental health scars from watching violence directed at her mother. When mothers are at the receiving end of violence, it can make their children physically ill, according to a growing body of research. Impact on children’s health Health data from 37 countries in sub-Saharan Africa found that children under the age of five whose mothers experienced intimate partner violence (IPV) were more likely to develop diarrhoeal disease and symptoms of acute respiratory infections, according to a study published in The Lancet last year. It called for tailored interventions to address childhood morbidity and mortality attributed to IPV in “priority countries” – Burkina Faso, Burundi, Chad, Comoros, Gabon, Liberia, Nigeria, Sierra Leone, South Africa, and Uganda. “The most important thing is actually the cumulative effect,” said Abel Dadi, lead author and a social epidemiologist at the Menzies School of Health Research at the Charles Darwin University in Australia. His study looked at exposure to three kinds of violence – physical, sexual and emotional. “When they come together, their effect increases,” he said. Dadi’s team also found a strong link between IPV and stunting in Burundi, and IPV and children being underweight in Burkina Faso, although the results were not consistent across all countries. What is not yet clear is the exact pathway of how IPV directed towards the mother affects a child’s physical health. A mother and newborn at a health center in the Patna district of Bihar, India. Babies’ health and well-being is deeply affected by their mother’s health. Pervasive violence The World Health Organization (WHO) recognizes that violence against women is a major public health issue. Globally, one third (27%) of women experience IPV in their lifetime, according to WHO figures. In sub-Saharan Africa, these rates are even higher, with 45·6% of women experiencing IPV in their lifetime. Young women aged 15 to 19 are the most affected by IPV. By the time they are 19 years old, almost a quarter of adolescent girls (24%) who have been in a relationship have already been physically, sexually, or psychologically abused by a partner, according to WHO data. However, while it is widely accepted that intimate partner violence affects a woman’s mental, physical and sexual health at risk, its impact on children has not received the same attention. But a child’s health and well-being are completely dependent on their mother during pregnancy, and heavily dependent in the early years, so a mother’s health and well-being directly affects her child’s health. The WHO, which developed a toolkit with UN Women to prevent violence against women in 2019, acknowledges that violence against women and against children often occurs in the same household. Psychiatrists like Bessel van der Kolk, who wrote ‘The Body Keeps the Score’, and Gabor Mate, author of ‘The Myth of Normal’, have also brought the lifelong impact of childhood trauma into the public domain, particularly of growing up with abusive parents. But IPV has long been seen as a criminal issue rather than a health issue. In India, for example, hospitals have only recently started to offer health workers training to see it as a public health problem. “I don’t think it is a well-understood field of work in terms of a response from the courts or from the state’s response to children’s rights,” said Julie Thekkudan, South Asia consultant at Equality Now, a global non-profit that advocates for women’s and girls’ rights. Each dot represents a different country in the region. There has been progress, with signs that IPV is reducing in some low- and middle-income countries due to progress in women’s empowerment. The reason women find it hard to leave abusive relationships, especially in the Global South, is that they have been socialized to tolerate violence, according to Thekkudan. In societies that favour sons and devalue daughters, girls are socialized into believing that their “purpose in life is to get married”, she explained. Staying in a marriage, even if it is abusive, and seen as part of “making sure that your family honor is maintained”, Thekkudan added. That, in addition to the fact that women don’t always have the financial ability to leave, makes it a harder choice. Dadi said that any intervention design on maternal health should consider intimate partner violence as well as the mental health of the mother. Currently, most of these kinds of interventions are concentrated in high-income countries, according to research. On average, countries that do better on gender equity indexes usually also experienc lower levels of violence against women, according to takeaways published in The Lancet. But a woman’s higher economic status can also make her vulnerable. One study from sub-Saharan Africa showed that women’s employment, especially if they were the sole earners or if they earned more than their male partner, was linked to a higher level of intimate partner violence. Any solution “has to be a multi-pronged, multi-level”, said Thekkudan. “I don’t think there is one solution that will change the entire system or the structure.” *Name changed to protect identity Image Credits: Photo by Alex Pasarelu on Unsplash, BMGF, World Bank. Brazil Wins Limited Backing for COP30 Climate-Health Plan, But Nations Commit No Finance 13/11/2025 Stefan Anderson Belém framework wins backing from two dozen nations, but health remains outside formal UN climate negotiations. Brazil launched a sweeping climate-health action plan on Thursday, named after the COP30 host city in the Amazon, winning initial endorsements from roughly two dozen countries for a voluntary framework calling on nations to strengthen disease surveillance, build climate-resilient infrastructure, and protect vulnerable populations from the health impacts of rising temperatures and extreme weather. The Belém Health Action Plan outlines 60 action items across surveillance systems, evidence-based policies, and health innovation to address the health risks facing 3.3 billion people globally affected by the climate crisis. “The climate crisis is one of the most significant health challenges of our time,” states the plan, developed by Brazil’s health ministry in consultation with the WHO. Countries that endorse the voluntary framework will report their progress through UN climate negotiations during the second Global Stocktake at COP33 in 2028. The World Health Organization calls climate change “the greatest single risk to humanity,” and the World Bank estimates it could cause up to 15.6 million deaths between 2026 and 2050, with health impacts costing $8.6 to $15.4 trillion by mid-century. Initial supporters include European Union states such as France and Spain, small island nations like Tuvalu, African countries from Congo to Zambia, and others including Canada, Japan, the United Kingdom and Malaysia. Brazil’s health minister Alexandre Padilha said the plan had received backing from more than 80 nations and institutions, though the vast majority comprises civil society organisations like the Global Climate and Health Alliance, global health actors including Medicines for Malaria Venture and Drugs for Neglected Diseases Initiative, and UN agencies such as UNFPA, UNICEF and UNITAID. “We expect to have more by the end of the day and the end of the COP,” Padilha said, adding the presidency would continue “trying to engage and mobilise” more countries. “There’s a very strong commitment from our government and ministers of health in this plan.” Delegates gather in the plenary hall of COP30 in Belem for the launch of the Brazil-WHO-led health-climate adaptation plan. The voluntary nature of the framework and broad support for the Alliance for Transformative Action on Climate and Health (ATACH) — a WHO-led initiative launched at COP26, which now counts 101 members — suggest endorsements will likely grow, but implementation remains uncertain. WHO will serve as the secretariat for the Belém plan, measuring outcomes through the ATACH framework. The sole explicit dissent Thursday came from Egypt, part of the Baku coalition of previous COP presidencies that helped draft the plan. Egypt’s health minister expressed willingness to join but voiced “concern about the reference to the inclusion of LGBTIQ+ individuals, as such patterns fall outside the nationally recognised policy frameworks in the cultural context of Egypt.” Other coalition members, the United Arab Emirates and Azerbaijan, expressed political will to continue discussions but stopped short of endorsement, instead noting they had “contributed” and “noted with interest” the framework’s goals. “We have to look at the impact of climate change, one of the main threats to public health in the world today,” Padilha said. “Scientific evidence has shown clearly that the climate crisis is first and foremost a crisis of public health throughout the world.” “The time of warnings has finished. Now we are living in a time of consequences,” he added. “The climate has already changed, so we have no alternative but to have public policies to adapt and face climate change.” No money from nations The voluntary adaptation framework was endorsed by around countries but faces billions in funding shortfalls. The launch came with no new financial commitments from endorsing nations. The sole funding announcement came from a coalition of philanthropies including the Gates Foundation, Wellcome Trust, and Rockefeller Foundation: a $300m one-time grant to support climate-health adaptation measures. That figure is dwarfed by estimates that low- and middle-income countries require at least $11 billion annually just for basic health adaptation covering only disease control for malaria, dengue, diarrheal diseases, heat-related mortality, and essential surveillance improvements, according to the UN Environment Programme. “Health systems, already stretched and underfunded, are struggling to cope with these growing pressures, and most are still unprepared for what is coming,” said Marina Romanello, executive director of the Lancet Countdown at University College London. “Existing finance falls short by billions. Without urgent investment, we will not be able to protect populations from escalating climate impacts.” The $11 billion annual UNEP pricetag excludes respiratory illnesses, malnutrition, mental health services, additional infectious disease programs, workers’ health protection, supply chain adaptation, and health system decarbonisation — most of what the Belém plan contains. The UNFCCC estimates global health adaptation will require $26.8 to 29.4 billion annually by 2050. Current health-specific climate finance reaching those countries totals perhaps $500 to $700 million annually, representing 2% of adaptation funding and 0.5% of multilateral climate finance. “With regards to finance, that reality is that we have a deficit that is quite colossal,” said Carlos Lopes, Special Envoy for Africa to the COP30 Presidency. A WHO survey of National Health Adaptation Plans found all included climate-health risks. But just 28 nations worldwide have completed such plans. As temperatures continue rising and extreme weather events intensify, pressure mounts for health system adaptation at a moment when global health financing faces unprecedented strain. Overall development assistance for health dropped 21% from nearly $50 billion in 2024 to $39 billion in 2025, driven largely by US withdrawal from global health programs. The WHO itself faces budget shortfalls of 15-20%. Climate-health financing has grown from less than $1 billion globally in 2018 to $7.1 billion in 2022, the only aid sector to grow in that time apart from education, according to Rockefeller Foundation analysis. But substantial portions arrive as loans: 24% of bilateral climate-health funding and more than 90% from the Asian Development Bank and Inter-American Development Bank. Many developing countries now spend more on servicing debt than on healthcare, with low-income countries spending roughly 300 times less per capita on health than wealthy nations. That finance shortfall impacts their ability to implement adaptation plans like the Belem Framework: A 2021 WHO survey found that while half of the countries reported having national health-climate strategies, less than a quarter achieved high implementation levels. Insufficient financing was identified as the key barrier by 70% of responding countries. Health’s struggles mirror wider climate adaptation finance gaps. At COP26 in 2021, developed countries pledged to triple overall adaptation finance from 2019 levels to at least $120 billion per year by 2025. Actual flows across all sectors totalled $26 billion in 2023. Money will determine whether Belém becomes an implemented plan or another symbolic declaration. Without tens of billions in annual funding, it will likely follow previous COP health commitments that failed to translate rhetoric into action. “The Belém Health Action Plan gives us the blueprint,” said Simon Stiell, executive secretary of the UN Framework Convention on Climate Change. “What we need now is sustained, coordinated and well-financed action to turn its promises into protection for all.” What’s the plan? Launch event for the Belem Health Action Plan at COP30. The Belém plan functions as a framework of best practice recommendations for adapting health systems to the climate crisis, containing no legally binding requirements or targets. Instead, the document outlines recommendations organized around surveillance systems, policy interventions, and infrastructure overhauls that officials say are essential to protecting billions from climate-driven health crises. The one specific requirement: Countries that endorse it will report progress through the Paris Agreement’s Global Stocktake by COP33 in 2028, with no enforcement mechanisms or compliance requirements. “For decades, WHO has been calling for action to adapt health systems and build resilience to climate change,” said Tedros Adhanom Ghebreyesus, WHO director-general. “The Belém health action plan is how we can do that.” “Health systems themselves are affected by climate change, compromising their ability to deliver life-saving care when people need it most,” he said. “There can be no healthy people on a sick planet.” The first focus: building the capacity to see threats coming. The framework calls for climate-informed health monitoring that links meteorological agencies with health institutions, using predictive modelling to trigger early warnings before heat waves, floods, or disease outbreaks overwhelm communities. Surveillance should also track which populations face the greatest risks, data officials say is often missing. The second area addresses policy interventions to protect communities, including clean energy and sustainable transport, heat protection for workers, mental health support woven into climate response, and targeted measures for Indigenous peoples and persons with disabilities. ”For many countries, adaptation is a question of survival in the short run. If you don’t adapt, it threatens the coverage of health services of patients and professionals who are already facing adverse conditions,” Padhila said. “If we don’t adapt, we are going to increase inequality. In short, if you don’t adapt, we will kill people.” Water & power “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. Finance will determine whether the Belém framework’s most ambitious element, climate-resilient infrastructure, can be delivered. The plan envisions health facilities built to withstand climate shocks, renewable energy powering clinics, telehealth platforms extending care, and strategic stockpiles of temperature-stable medicines and vaccines. It calls for “integrated methodologies linking environmental, meteorological, social, climate and health monitoring data” with real-time surveillance and digital technologies as “structural components.” The problem: roughly 100,000 health facilities in sub-Saharan Africa lack reliable electricity, affecting nearly a billion people worldwide. Up to 70% of medical equipment in developing countries sits unused due to power failures. Cold chains for vaccines, digital surveillance systems, early warning platforms, and telehealth services all depend on reliable power that serving populations don’t have. Closing the healthcare electrification gap by 2030 would cost $4.9 billion, about $5 per person affected over six years. That’s less than one year of current global climate-health spending. “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. “It is very important we have the policies… working on the value chains of electricity to make sure that our babies, who are getting born without electricity,” have access to care. Water and sanitation infrastructure are equally critical, she noted. “If we bring water, we bring sanitation. There is already a disease that we will put away. We can tell our boys and girls to wash their hands, but how could they do it if there is no water at the school?” Just three nations have completed all four ATACH assessments as of 2025. The Belém plan’s success will depend not just on building infrastructure, but on countries’ ability to track and report progress. WHO will measure implementation through ATACH, its Alliance for Transformative Action on Climate and Health, which already requires members to complete vulnerability studies, adaptation plans, emissions inventories, and decarbonization roadmaps. The record so far suggests those demands exceed many countries’ capacity. Four years after ATACH’s launch in 2021, only three countries—France, Japan, and the UK—have completed all four assessments. Across 88 countries with available data, roughly 35-40% completed vulnerability assessments and 30% finished adaptation plans. In Africa, fewer than 10 of 29 ATACH members have completed vulnerability assessments. The Belém plan now adds reporting requirements on top of those existing gaps: tracking mental health impacts, monitoring workers’ heat exposure, establishing community resilience programmes, and climate-proofing supply chains, all by 2028. That creates an impossible bind. France, Japan, and the UK have the technical capacity and resources to meet these demands. Many other countries lack not only the expertise for complex reporting systems, but the basic infrastructure, electricity and water, that the plan assumes as a foundation. “Finance is still the bottleneck for us,” Princess Djigma said. Fossil fuel phase-out excluded Delegates arrive for the opening day of COP30 on the edge of the Brazilian Amazon. Notably absent from the plan is any reference to phasing out fossil fuels, the main driver of climate change and the resulting heat, extreme weather and air pollution killing approximately 8m people annually from respiratory and cardiovascular diseases. The omission came at the explicit instruction of the Brazilian COP30 presidency, according to people familiar with the negotiations. The exclusion comes as the International Energy Agency warned Wednesday that global oil and gas demand will rise for the next 25 years if countries do not change course. Until this year, all of the Paris-based body’s modelling assumed fossil fuel consumption would peak this decade. “Climate change is declining — and declining rapidly — in the international energy policy agenda,” said Fatih Birol, the IEA’s executive director. “And this is happening while 2024 was the hottest year in history.” Fifteen countries allocated more resources to fossil fuel net subsidies than their entire national health budgets. Birol’s findings align with the Lancet Countdown report published ahead of the summit, which found the 100 largest oil and gas companies have production strategies that put them on track to exceed their share of production consistent with 1.5 °C of heating by 189% in 2040, up from 183% in March 2024. Private bank lending to fossil fuel activities surged 29% to $611 billion in 2024, exceeding green sector lending by 15%. Some 73 of 87 countries reviewed provided net explicit fossil fuel subsidies in 2023, allocating nearly $1 trillion in direct support. Including indirect subsidies, that figure rises to over $7tn, according to the International Monetary Fund — more than governments spend annually on education and about two-thirds of what they spend on healthcare. The declining political attention extends to international engagement: Mentions of health and climate change by governments in their annual UN General Assembly statements declined from 62% in 2021 to 30% in 2024, according to the Lancet Countdown. “Record deaths from climate-driven wildfires in 2023 show that there’s no adaptation without mitigation,” said Nina Renshaw, head of health at the Clean Air Fund. “Ministries of Health and Finance won’t be able to bail hospitals and clinics out of the climate emergency if governments don’t stop the emissions which are already causing unprecedented harm.” ‘More than dialogue’ Delegates convened for the first-ever Health Day at a UN climate summit in Dubai. The Belém plan follows a pattern established at recent climate summits: the COP28 Dubai Health Declaration signed by 143 countries, the Baku Coalition for Climate and Health launched last year, and efforts stretching back to Glasgow in 2021. Like those efforts, Belém is a non-binding, voluntary process taking place outside formal UN negotiations. Criticisms of the outcomes of Dubai and Baku describe their outcomes as symbolic gestures that generate attention but fail to secure funding, sustained commitment, or implementation. Officials on Thursday repeatedly stressed the need to break the holding pattern. “This gathering must be more than dialogue,” said Jarbas Barbosa, director of the Pan American Health Organization. “It must galvanise collective action and inspire new policies dedicated to protecting everyone’s health from the worsening effects of climate change.” “The climatic crisis is fundamentally a health crisis,” Barbosa said. “We are not talking any more about distant or possible threats. Climate change is a present and growing reality.” Whether the Belém framework can overcome the obstacles that have stymied previous declarations — insufficient financing, limited technical capacity, competing priorities — remains uncertain. But Padilha argued the world has no choice but to try. “We are faced with a dilemma: we either continue to speak and speak and talk, or we can walk the walk and make the political commitment to do so,” he said. “We cannot accept the erosion of multilateralism in global health. Those who deny multilateralism are surrounding us. We will not listen to them.” Image Credits: COP30, COP30, COP30, COP30, COP30, COP30, WHO . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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World Falls Far Short of Methane Cut Targets Halfway to 2030 Deadline 18/11/2025 Stefan Anderson Infrared camera reveals escaped methane emissions from oil rig. Methane leaks from oil and gas make a major contribution to global warming. First UN assessment since the 2021 Glasgow pledge shows methane cuts falling far short of targets needed to meet climate goals. Accelerated action could yield $330 billion in annual benefits by 2030 through improved health and reduced crop losses. Four years after more than 100 countries pledged to slash methane emissions 30% by the end of the decade, a UN assessment has found nations are on track to deliver barely a quarter of that target. The Global Methane Status Report, released Monday at COP30 in the Brazilian Amazon city of Belém, found that current national commitments would cut global methane emissions by just 8% below 2020 levels by 2030. Despite the lack of progress, the 30% target remains technically achievable with increased investment and policy-driven reform, the report found, adding it could yield some $330 billion in benefits to health and cost production, nearly double the cost of investment in methane emissions mitigation. While methane emissions are not a part of formal negotiations in the UN Framework Convention on Climate Change (UNFCC)C, it is the world’s second largest contributor to global warming, after CO2, with a global warming potential 86 times greater. A precursor to ground-level ozone formation, methane is a contributor to air pollution-related deaths as well as reduced crop yields. With an atmospheric lifespan of only about 12 years, reducing methane emissions can yield enormous co-benefits for health as well as reducing the pace of climate change. Collective, non-binding target The Global Methane Status Report produced by the UN Environment Programme is the first comprehensive stocktake of global progress on methane emissions since reduction targets were announced at COP26. The assessment comes as global methane concentrations have reached the highest levels in at least 800,000 years, more than 2.6 times pre-industrial levels, with the gas responsible for roughly one-third of present-day global warming. The new report compiled by the UN Environment Programme is the first comprehensive stocktake since the Global Methane Pledge was launched at the UN climate summit in Glasgow, COP26. The Global Methane Pledge, a non-binding political commitment signed by 159 countries, set a collective global reduction target rather than assigning specific cuts to individual countries or sectors, leaving nations to develop their own strategies and action plans. “Slow climate action means that the multi-decade average of global temperatures will exceed 1.5°C within the next decade,” Ruth do Cutto, deputy climate change chief at UNEP said at a press briefing launching the report. “We must make sure that this overshoot is as short and as low in temperature as possible, and we cannot do that without curbing emissions of methane, which is responsible for one-third of today’s global warming.” Methane’s potency as a greenhouse gas, combined with its relatively short atmospheric lifespan, makes cutting emissions one of the fastest ways to slow near-term temperature rise, often called an environmental “hand brake” by climate experts. “Lack of time is our biggest challenge,” said COP30 President Ana Toni, noting that slashing methane emissions “delivers the fastest results” for slowing warming. Full deployment of what the report calls “maximum technically feasible reductions” could still cut emissions 32% below 2020 levels by 2030, even surpassing the pledge target. These measures would cost an estimated $127 billion annually but deliver benefits valued at $330 billion per year by 2030, including preventing more than 180,000 premature deaths, avoiding 19 million tonnes of crop losses, and reducing global temperatures by 0.2°C by mid-century. “We’re on a highway to hell with the foot on the gas pedal,” Martina Otto, head of the Climate and Clean Air Coalition Secretariat, which produced the report with the UN Environment Programme, said at the launch event in Belém. “If we are heading towards the wall, you don’t just pull the handbrake a little bit. You pull it forcefully and fast. And I think that’s where we are right now,” Otto said. Slow momentum, US wildcard The 159 countries now signed to the pledge, up from just over 100 at launch, represent nearly half of global methane emissions. However, three of the world’s top five emitters remain outside the agreement: China, the largest overall source, India and Russia. China’s participation in a methane summit co-hosted with Brazil and the United Kingdom on the sidelines of COP30 marked a notable diplomatic shift, though Beijing has yet to sign the global methane pledge. Since the pledge’s launch, projected 2030 emissions have improved modestly. Some 127 countries, representing 65% of Paris Agreement parties, now include methane mitigation measures in their latest Nationally Determined Contributions, a 38% increase from pre-2020 levels. New waste management regulations in Europe and North America, combined with slower-than-expected growth in natural gas markets between 2020 and 2024, have lowered forecast emission levels by 14 million tonnes compared with 2021 projections, UNEP found. The emissions decrease documented in the report is relative to levels projected in 2021, not a net reduction. While methane emissions were on track to increase by 13% by 2030, that would fall to 5% if nations follow through on pledged cuts. Overall, global methane emissions continue to rise, reaching approximately 352 million tonnes in 2020 and projected to hit 369 million tonnes by 2030 under current legislation. “If countries fully implement their existing methane plans submitted as of June 2025, global emissions could fall by about 8% this decade,” Otto said. “That would constitute the largest and most sustained decline in methane emissions ever recorded. So it works, but it doesn’t work fast enough.” The report’s modelling does not account for the United States reversing its methane commitments. While the US was once a leading nation in advocating methane emissions cuts and a core author of the 2021 pledge in Glasgow, the Trump administration has rolled back domestic methane policies and pressured the European Union to delay implementation of new methane emissions regulations that would increase reporting transparency. Some US states, including California, have maintained stricter methane reporting requirements. Agriculture, energy and waste lead methane-emitting sectors Global anthropogenic methane emissions in the current policies scenario, 1990–2050, million tonnes per year The UNEP report found that agriculture accounts for 42% of global methane emissions, the energy sector 38%, and waste 20%. The G20 countries plus the European Union and several other developed nations are responsible for 65% of total emissions, with China taking the top spot. The energy sector offers the largest mitigation opportunity, UNEP said, with 72% of technically feasible reductions by 2030 concentrated in oil, gas and coal operations. More than 80% of the total reduction potential across all sectors can be achieved at costs below $36 per tonne of CO2 equivalent, with many fossil fuel measures actually profitable because they capture gas that can be sold rather than vented or flared. Inger Andersen, executive director of UNEP, said “reducing methane emissions is one of the most immediate and effective steps we can take to slow the climate crisis while protecting human health.” Chloe Brimicombe, a climate scientist at the Royal Meteorological Society, linked methane emissions to more frequent and intense heatwaves, which kill nearly 600,000 people annually. “Heat puts immense stress on the body, particularly for children, older people and those with chronic illness,” she said, describing methane cuts as a “fast and effective way to help protect communities from heat-related illness and deaths.” “Reducing methane decreases the precursors of ground-level ozone, reducing cardiovascular and respiratory disease immediately,” said Courtney Howard, an emergency physician and chair of the Global Climate and Health Alliance. “Cutting methane is a win-win for health and health systems now and into the future.” ‘On the radar’ Global anthropogenic methane emissions under different scenarios, 1990–2050, million tonnes per year. Regional studies “continue to reveal significant underreporting of methane emissions, particularly within the fossil fuel sector,” the report found. Dan Jørgensen, European Commissioner for Energy and Housing, said nearly 90% of satellite-detected emission events still go unaddressed by governments and fossil-fuel companies. Liz Thompson, climate ambassador of Barbados, called reining in these oversights a “matter of survival” for small island nations. “We need oil and gas companies to recognise the importance of cutting methane emissions by stopping flaring and leaks,” she said. “Over the next year, we must advance discussions so that COP31 can perhaps present a concrete proposal to initiate efforts that will lead to a legally binding agreement.” Current methane-focused investment has reached $13.7 billion annually, up 18% in recent years but far below the $127 billion needed by 2030. Measures in the fossil fuel sector could be deployed at little to no net cost, with bills for the energy sector overall representing just 2 to 4% of the industry’s 2023 income, according to the report. “It shows that methane has made it onto the radar and that we’ve gained momentum, that cost-effective solutions exist today, essentially waiting to be brought to scale, and that the benefits are enormous,” Otto said. “We can do it, but we have to act much faster.” China’s participation in COP30 methane summit marks a shift The report launch coincided with a “methane summit’’ co-hosted by Brazil, China and the United Kingdom on the sidelines of COP30. The summit launched a “Super Pollutant Country Action Accelerator” providing $25 million in initial funding for seven developing countries to establish dedicated national methane units, modelled on the successful Montreal Protocol ozone programmes. China’s participation marked a significant diplomatic development, as Beijing co-hosted the event despite not being a signatory to the Global Methane Pledge. The country is the world’s largest methane emitter, primarily from its massive coal mining sector. “The summit not only underscores the critical role of controlling methane and other non-CO2 greenhouse gas emissions in the global response to climate change, but also encourages all parties to share the policies and actions they have taken in the emission reduction process,” Huang Runqiu, China’s environment chief, said at the summit. “Climate change is a global challenge, and addressing it requires concerted efforts from the entire world.” The UK also led a statement signed by Canada, France, Germany, Japan, Kazakhstan and Norway committing to drastically reduce methane emissions in the fossil fuel sector, including ending routine flaring and venting by 2030 and developing a “near-zero methane intensity marketplace” by 2026 to use trade measures to reward low-emission producers. “The global methane pledge has had an impact. It supported the reshaping of national priorities,” Otto said. However, she noted the report had to exclude the latest round of national climate plans submitted after June 2025 from its modelling. “Obviously, we have seen new coming in, but we had to do the modelling at one point, and so that became our cut-off.” Beyond 2030, the report warned that technical fixes alone will prove insufficient. Meeting 1.5C or 2C warming targets will require combining methane controls with broader energy decarbonisation and demand-side measures, including dietary shifts and reduced food waste, potentially cutting emissions 53% below 2020 levels by 2050. “We can still make it,” Otto said. “But it will take a whole lot of additional effort. It’s not possible if we do it half-heartedly.” With five years remaining until the 2030 target, “the choices made in the next five years will determine whether the world seizes this opportunity, unlocking cleaner air, stronger economies, and a safer climate for generations to come,” UNEP concluded. Image Credits: Clean Air Task Force . Former DOGE Official Driving US Bilateral Health Agreements With African Countries 17/11/2025 Kerry Cullinan US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenyan Treasury and health officials. The United States government is moving rapidly to secure Memorandums of Understanding (MOU) with African countries that offer limited health aid for five years in exchange for 25 years’ access to countries’ data about “pathogens with epidemic potential”. Some commentators have described the terms of the bilateral MOUs as “extractive” as they fail to offer African countries access to the health products that might be developed from the pathogen material that they share. The process is being driven by Brad Smith, formerly one of the leaders of Elon Musk’s Department of Government Efficiency (DOGE), who was responsible for implementing deep cuts to the US Health and Human Services (HHS) department. Smith is now a global health advisor in the US State Department, overseeing the reorganisation of the US President’s Emergency Plan for AIDS Relief (PEPFAR) and health grants from the now defunct US Agency for International Development (USAID). He was part of the US delegation that met Kenyan health and finance officials last week to discuss its MOU. So too was Bethany Kozma, a former USAID official during the first Trump administration and a fervent anti-abortion campaigner. She is currently chief advisor for policy and strategy in the HHS Global Affairs Office. Bethany Kozma, anti-abortion campaigner and chief advisor for policy and strategy in the HHS Global Affairs Office, also attended the meeting with Kenya. Dr Chris Kiptoo, Kenyan Treasury’s Principal Secretary, reported after last week’s meeting that “both countries are finalising a bilateral agreement that aligns Kenya’s health priorities with the United States’ global health objectives, strengthening a partnership that saves lives and builds a more resilient health system for our nation”. Meanwhile, Rwandan Health Minister Dr Sabin Nsanzimana met a US delegation headed by Dr Mamadi Yilla, US State Department deputy assistant secretary for health diplomacy, last week to discuss a new MOU. Rwandan Health Minister Dr Sabin Nsanzimana and Dr Mamadi Yilla, US deputy assistant secretary for global health diplomacy and other officials. Smith also led the US delegation to Zambia on Monday (17 November), where he met Zambia’s Health Minister, Dr Elijah Muchima, and Finance Minister Situmbeko Musokotwane. The meeting aimed to “chart a new course for US health assistance to Zambia”, according to the US Embassy in Zambia. “The new approach envisions both governments committing to funding levels and health outcome performance objectives in order to accelerate the transition from an aid-dependent health sector to a Zambian government-led health system that is able to sustainably meet the health needs of the Zambian people,” according to the US media release. US official Brad Smith and Zambian Finance Minister Situmbeko Musokotwane. Extensive access to data The MOUs include clauses that would give the US extensive access to country health databases and contain punitive measures for countries that fail to provide this access or pathogen information, including unspecified “changes in the planned assistance” or total discontinuation of aid. Conversely, those that meet targets may get unspecified rewards. While the agreements contain a list of targets (“outcome metrics) for reducing HIV, TB, malaria, maternal and under-five mortality, and increasing measles vaccinations, details about how these will be achieved are scanty. In contrast to the health services section, the “surveillance and outbreak response” section is far more detailed, with budget allocations and staff numbers. For instance, Zambia is expected to employ “1,723 field epidemiologists” in 2026 at its own expense to meet its outbreak surveillance and pathogen-sharing requirements, according to a draft seen by Health Policy Watch. The US also notes in the draft Zambian MOU that it is making a $50 million cut to its previous commitment of $120 million in funding for antiretroviral (ARV) medicine and HIV tests due to “historic theft”. This relates to a 2021 scandal where it emerged that ARVs donated to Zambia were being sold in pharmacies. Countries need the capacity to detect disease outbreaks within seven days and report to the US on these within a day of an outbreak being detected, according to the MOUs. Twenty-five years’ access for five-year grants Countries also have to commit to signing a 25-year “specimen sharing agreement”, although the MOUs only cover a five-year grant period. This agreement will cover “sharing physical specimens and related data, including genetic sequence data, of detected pathogens with epidemic potential for either country within five days of detection”. However, an annex that is supposed to set out the “elements” of the agreement is blank. Bizarrely, the MOUs also want governments to commit to a 25-year “data sharing arrangement” for “exchanging data on the long-term performance of this MOU and for accountability to the United States Congress for appropriated funds”. However, the country grants will only run from 1 April 2026 until 2030. Author Emily Bass published a template for this data-sharing arrangement over the weekend, saying that it “reveals the unprecedentedly extractive nature of these ongoing negotiations”. The US wants access to a range of data, including electronic medical records, health management and information systems, and outbreak response and surveillance data systems. “This agreement affords the US at-will visibility into digital systems, including those, like electronic medical records, that include personal identifiable information,” Bass notes. In the audit section, the MOUs stress that countries need to provide the US with “any data access or information needed to monitor compliance with applicable legal requirements, including to confirm no US government funding is being used for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions”. The MOU concludes by noting that it is not a legally binding document but “a record of the intentions of the parties”. Bypassing WHO? Member states started to negotiate a pathogen access and benefit-sharing system at the WHO headquarters in Geneva recently. By placing itself at the centre of rapid information-sharing about dangerous pathogens, the US appears to be attempting to usurp the World Health Organization (WHO). WHO member states are currently negotiating a Pathogen Access and Benefit Sharing (PABS) system that unite countries, pharmaceutical companies and non-profits in a single process aimed at speedily sharing information and developing counter-measures for pathogens that can cause pandemics. The US and Argentina are the only countries that have opted out of these negotiations. However, if the US is the gatekeeper of pathogen information via these MOUs, this likely to fracture and slow down the global response to pandemics. In addition, US companies could also get the first shot at developing vaccines, therapeutics and diagnostics for these pathogens. Aggrey Aluso of Resilience Action Network Africa (RANA) warned that while governments “should explore deals that could benefit the lives of their people and their economy, such deals should not be extractive”. “Global health security cannot be built on coercive conditionalities,” Aluso told Health Policy Watch. “True preparedness demands equity, respects data sovereignty, and is grounded in solidarity — not transactions that deepen inequities and silence the voices of those most affected. The current version of the proposed MOUs need an inclusive, equity-centred approach.” Health Systems Are Unprepared for The Climate Crisis 14/11/2025 Stefan Anderson The synthesis report follows the launch of the Belém Health Action Plan at COP30, a voluntary best practice framework to assist governments in adapting their health systems for climate change. Nations worldwide must finance and implement climate adaptation measures for health systems or risk losing millions of lives as extreme weather, rising temperatures, and intensifying heat threaten healthcare access for nearly half the global population, according to a report published Friday by the World Health Organization and Brazil. The special report, released at the COP30 summit in Belém, follows Thursday’s launch of the Belém Health Action Plan, which won backing from roughly two dozen countries but secured no financial commitments from governments. The only funding to support the plan came from philanthropies: a $300 million one-time grant. The report estimates health system adaptation needs at $22 billion per year by 2035. “The climate crisis is a health crisis – not in the distant future, but here and now,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This special report provides evidence on the impact of climate change on individuals and health systems, and real-world examples of what countries can do – and are doing – to protect health and strengthen health systems.” The past decade has been the hottest on record, with global temperatures exceeding 1.5°C above pre-industrial levels for the first time in 2024. Updated Climate Tracker projections published at the UN climate summit on Wednesday show the world on track for 2.5°C of warming, while the UN Environment Programme projected last week that a business-as-usual scenario has the world heading for 2.8°C. Every fraction of a degree endangers millions. “Many health systems are fragile, lacking climate-trained personnel, resilient infrastructure and adequate surveillance,” said Simon Stiell, executive secretary of the UN Framework Convention on Climate Change. “Watching super typhoons and flash floods rip through hospitals and local health clinics is heartbreaking, but lamenting is not a strategy. We need real solutions.” Simon Still, executive secretary of the UNFCCC, addresses COP30’s opening plenary. “The real challenges people face, such as extreme heat, air pollution, infectious diseases, mental health and food insecurity – humanity can only win this global climate fight if we connect stronger climate actions to people’s top priorities in their daily lives, and there are few higher priorities than our health,” Stiell said. The report does not present new evidence, functioning instead as a synthesis of the best available science and data on the risks posed to unprepared health systems by climate change, drawing on academic literature, government and UN reports, and real-world case studies. “Recent tragedies show that now is the time to implement policies and actions that address the impacts of climate change on health,” said Alexandre Padilha, Brazil’s health minister. “The Belém Health Action Plan and this report offer countries the tools they need to turn scientific evidence into concrete action.” As storms batter coastlines, floods displace communities, and droughts fuel conflict and hunger, the report paints a picture of health systems under mounting strain. The familiar but alarming statistics form the case to policymakers to invest in adaptation and join the Belém plan. More than 540,000 people now die annually from extreme heat, a 63% rise since the 1990s. Between 3.3 and 3.6 billion people live in regions highly vulnerable to climate change. One in twelve of the world’s 200,000 hospitals face the risk of total shutdown due to extreme weather events under high-emissions scenarios, with more than 70% of at-risk facilities located in low- and middle-income countries. Hospitals and health facilities are also 41% more likely to suffer damage from extreme weather events than in 1990. “Climate change is an unavoidable reality that challenges public health and adds pressure on already overwhelmed systems,” Padilha said, calling policies to protect the health sector one of the “most strategic decisions of the 21st century.” “Protecting lives, reducing inequalities, and bolstering the resilience of health systems are no longer just goals – they have become ethical and democratic imperatives,” he said. Mitigation left out of the main Belém text Brazil’s COP30 presidency chose the Amazon city of Belém in an effort to remind negotiators of the planet they are fighting to protect. While the report and Belém Health Action Plan focus on preparing health systems for climate impacts, the synthesis document draws a clear conclusion about what would most protect those systems: cutting emissions. “The evidence is clear: urgent and sustained mitigation across all sectors is the single most important health adaptation intervention,” states the executive summary. “There are profound physical, financial, and technological limits to adaptation, and health systems cannot remain resilient in a world of unchecked warming.” By reducing emissions, health systems would face less extreme weather events, fewer heat deaths, and smaller disease burdens, making adaptation needs less severe in the first place. That finding sits awkwardly with the Belém Health Action Plan itself, which contains no references to phasing out fossil fuels, the main driver of climate change. The fossil fuel omission came at the explicit instruction of the Brazilian COP30 presidency, according to people familiar with the negotiations, likely to open the door for more nations to sign on who will not commit to language on fossil fuel phase-out. What the report identifies as “the most effective measure” to protect health systems is excluded from the political Belém framework, which requires endorsement from governments, instead relegated to a supporting document with no political weight. “When COP30 delegates leave Belém, success will be measured by the courage governments have demonstrated to act on what is already known: that fossil fuels are destroying people’s health,” said Jeni Miller, health lead at the Global Climate and Health Alliance. “To ignore these realities would be to betray both science and humanity.” A $20 billion gap Adaptation needs for health systems estimated in the COP30 special report. Direct health sector adaptation interventions will require more than $22 billion annually by 2035, according to the report, approximately 7% of total adaptation financing needs in climate-vulnerable countries. Current health-specific climate finance reaching those countries totals around $500 to $700 million annually, representing 2% of adaptation funding and 0.5% of multilateral climate finance. Climate and health finance has grown considerably in recent years, rising tenfold from less than $1 billion in 2018 to $7.1 billion in commitments between 2018 and 2022, according to analysis published earlier this year by the Rockefeller Foundation, WHO and other partners. In 2022, this included $4.8 billion from bilateral donors, $600 million from multilateral development banks, $1.5 billion from multilateral health funds, and $130 million from philanthropies. The share of climate finance targeting the health sector increased from 1% in 2018 to 9% in 2022, the only sector apart from education to see an increase. Yet these flows remain far below estimated needs, and more than 90% of health adaptation funding from development banks arrives as loans rather than grants. “The evidence is clear that we have been too slow to act on climate change and we are now ill-equipped to cope with rising temperatures across the world,” said Alan Dangour, health and climate lead at the Wellcome Trust. The report identifies persistent gaps in readiness. Only 54% of national health adaptation plans assess risks to health facilities. Fewer than 30% of health adaptation studies consider income, 20% consider gender, and less than 1% include people with disabilities. More than 60% of National Adaptation Plans have no formal tracking or evaluation in place. “Extreme heat, air pollution and infectious disease all hit the most vulnerable hardest: children, pregnant people, older adults, outdoor workers, and communities with the fewest resources,” Dangour said. “At COP30 and beyond, governments must act on the science – cut emissions, invest in adaptation, and put health at the heart of climate action. Lives, economies, and our future depend on the solutions we deliver now.” Image Credits: COP30, COP30. How Intimate Partner Violence Affects Children 14/11/2025 Disha Shetty Children’s health suffers in households where their mothers are abused. Noma Bolani has a clear memory of her abusive father stopping the car in the middle of the highway in Durban, South Africa and asking her mother to get out. She was just six years old, but Bolani followed her mother out of the car, and together they sought help from a passing motorist. Bolani is now 38, and has anxiety stemming from early childhood experiences related to growing up with an abusive father and witnessing her mother being at the receiving end of emotional and financial violence. Ayesha*, 34, from New Delhi, India, grew up watching her mother being subjected to physical, emotional and financial violence from her father. He would sometimes also resort to silent treatment that would last weeks, refuse to pay school fees for Ayesha and her sister and resort to physical violence using belts, shoes and, at times, utensils. Ayesha suffers from Polycystic Ovary Disease (PCOD) that affects the regularity of her periods and causes hormonal changes. Her doctor believes the stress she was subjected to as a child played a significant role in worsening her PCOD. Like Bolani, Ayesha also carries mental health scars from watching violence directed at her mother. When mothers are at the receiving end of violence, it can make their children physically ill, according to a growing body of research. Impact on children’s health Health data from 37 countries in sub-Saharan Africa found that children under the age of five whose mothers experienced intimate partner violence (IPV) were more likely to develop diarrhoeal disease and symptoms of acute respiratory infections, according to a study published in The Lancet last year. It called for tailored interventions to address childhood morbidity and mortality attributed to IPV in “priority countries” – Burkina Faso, Burundi, Chad, Comoros, Gabon, Liberia, Nigeria, Sierra Leone, South Africa, and Uganda. “The most important thing is actually the cumulative effect,” said Abel Dadi, lead author and a social epidemiologist at the Menzies School of Health Research at the Charles Darwin University in Australia. His study looked at exposure to three kinds of violence – physical, sexual and emotional. “When they come together, their effect increases,” he said. Dadi’s team also found a strong link between IPV and stunting in Burundi, and IPV and children being underweight in Burkina Faso, although the results were not consistent across all countries. What is not yet clear is the exact pathway of how IPV directed towards the mother affects a child’s physical health. A mother and newborn at a health center in the Patna district of Bihar, India. Babies’ health and well-being is deeply affected by their mother’s health. Pervasive violence The World Health Organization (WHO) recognizes that violence against women is a major public health issue. Globally, one third (27%) of women experience IPV in their lifetime, according to WHO figures. In sub-Saharan Africa, these rates are even higher, with 45·6% of women experiencing IPV in their lifetime. Young women aged 15 to 19 are the most affected by IPV. By the time they are 19 years old, almost a quarter of adolescent girls (24%) who have been in a relationship have already been physically, sexually, or psychologically abused by a partner, according to WHO data. However, while it is widely accepted that intimate partner violence affects a woman’s mental, physical and sexual health at risk, its impact on children has not received the same attention. But a child’s health and well-being are completely dependent on their mother during pregnancy, and heavily dependent in the early years, so a mother’s health and well-being directly affects her child’s health. The WHO, which developed a toolkit with UN Women to prevent violence against women in 2019, acknowledges that violence against women and against children often occurs in the same household. Psychiatrists like Bessel van der Kolk, who wrote ‘The Body Keeps the Score’, and Gabor Mate, author of ‘The Myth of Normal’, have also brought the lifelong impact of childhood trauma into the public domain, particularly of growing up with abusive parents. But IPV has long been seen as a criminal issue rather than a health issue. In India, for example, hospitals have only recently started to offer health workers training to see it as a public health problem. “I don’t think it is a well-understood field of work in terms of a response from the courts or from the state’s response to children’s rights,” said Julie Thekkudan, South Asia consultant at Equality Now, a global non-profit that advocates for women’s and girls’ rights. Each dot represents a different country in the region. There has been progress, with signs that IPV is reducing in some low- and middle-income countries due to progress in women’s empowerment. The reason women find it hard to leave abusive relationships, especially in the Global South, is that they have been socialized to tolerate violence, according to Thekkudan. In societies that favour sons and devalue daughters, girls are socialized into believing that their “purpose in life is to get married”, she explained. Staying in a marriage, even if it is abusive, and seen as part of “making sure that your family honor is maintained”, Thekkudan added. That, in addition to the fact that women don’t always have the financial ability to leave, makes it a harder choice. Dadi said that any intervention design on maternal health should consider intimate partner violence as well as the mental health of the mother. Currently, most of these kinds of interventions are concentrated in high-income countries, according to research. On average, countries that do better on gender equity indexes usually also experienc lower levels of violence against women, according to takeaways published in The Lancet. But a woman’s higher economic status can also make her vulnerable. One study from sub-Saharan Africa showed that women’s employment, especially if they were the sole earners or if they earned more than their male partner, was linked to a higher level of intimate partner violence. Any solution “has to be a multi-pronged, multi-level”, said Thekkudan. “I don’t think there is one solution that will change the entire system or the structure.” *Name changed to protect identity Image Credits: Photo by Alex Pasarelu on Unsplash, BMGF, World Bank. Brazil Wins Limited Backing for COP30 Climate-Health Plan, But Nations Commit No Finance 13/11/2025 Stefan Anderson Belém framework wins backing from two dozen nations, but health remains outside formal UN climate negotiations. Brazil launched a sweeping climate-health action plan on Thursday, named after the COP30 host city in the Amazon, winning initial endorsements from roughly two dozen countries for a voluntary framework calling on nations to strengthen disease surveillance, build climate-resilient infrastructure, and protect vulnerable populations from the health impacts of rising temperatures and extreme weather. The Belém Health Action Plan outlines 60 action items across surveillance systems, evidence-based policies, and health innovation to address the health risks facing 3.3 billion people globally affected by the climate crisis. “The climate crisis is one of the most significant health challenges of our time,” states the plan, developed by Brazil’s health ministry in consultation with the WHO. Countries that endorse the voluntary framework will report their progress through UN climate negotiations during the second Global Stocktake at COP33 in 2028. The World Health Organization calls climate change “the greatest single risk to humanity,” and the World Bank estimates it could cause up to 15.6 million deaths between 2026 and 2050, with health impacts costing $8.6 to $15.4 trillion by mid-century. Initial supporters include European Union states such as France and Spain, small island nations like Tuvalu, African countries from Congo to Zambia, and others including Canada, Japan, the United Kingdom and Malaysia. Brazil’s health minister Alexandre Padilha said the plan had received backing from more than 80 nations and institutions, though the vast majority comprises civil society organisations like the Global Climate and Health Alliance, global health actors including Medicines for Malaria Venture and Drugs for Neglected Diseases Initiative, and UN agencies such as UNFPA, UNICEF and UNITAID. “We expect to have more by the end of the day and the end of the COP,” Padilha said, adding the presidency would continue “trying to engage and mobilise” more countries. “There’s a very strong commitment from our government and ministers of health in this plan.” Delegates gather in the plenary hall of COP30 in Belem for the launch of the Brazil-WHO-led health-climate adaptation plan. The voluntary nature of the framework and broad support for the Alliance for Transformative Action on Climate and Health (ATACH) — a WHO-led initiative launched at COP26, which now counts 101 members — suggest endorsements will likely grow, but implementation remains uncertain. WHO will serve as the secretariat for the Belém plan, measuring outcomes through the ATACH framework. The sole explicit dissent Thursday came from Egypt, part of the Baku coalition of previous COP presidencies that helped draft the plan. Egypt’s health minister expressed willingness to join but voiced “concern about the reference to the inclusion of LGBTIQ+ individuals, as such patterns fall outside the nationally recognised policy frameworks in the cultural context of Egypt.” Other coalition members, the United Arab Emirates and Azerbaijan, expressed political will to continue discussions but stopped short of endorsement, instead noting they had “contributed” and “noted with interest” the framework’s goals. “We have to look at the impact of climate change, one of the main threats to public health in the world today,” Padilha said. “Scientific evidence has shown clearly that the climate crisis is first and foremost a crisis of public health throughout the world.” “The time of warnings has finished. Now we are living in a time of consequences,” he added. “The climate has already changed, so we have no alternative but to have public policies to adapt and face climate change.” No money from nations The voluntary adaptation framework was endorsed by around countries but faces billions in funding shortfalls. The launch came with no new financial commitments from endorsing nations. The sole funding announcement came from a coalition of philanthropies including the Gates Foundation, Wellcome Trust, and Rockefeller Foundation: a $300m one-time grant to support climate-health adaptation measures. That figure is dwarfed by estimates that low- and middle-income countries require at least $11 billion annually just for basic health adaptation covering only disease control for malaria, dengue, diarrheal diseases, heat-related mortality, and essential surveillance improvements, according to the UN Environment Programme. “Health systems, already stretched and underfunded, are struggling to cope with these growing pressures, and most are still unprepared for what is coming,” said Marina Romanello, executive director of the Lancet Countdown at University College London. “Existing finance falls short by billions. Without urgent investment, we will not be able to protect populations from escalating climate impacts.” The $11 billion annual UNEP pricetag excludes respiratory illnesses, malnutrition, mental health services, additional infectious disease programs, workers’ health protection, supply chain adaptation, and health system decarbonisation — most of what the Belém plan contains. The UNFCCC estimates global health adaptation will require $26.8 to 29.4 billion annually by 2050. Current health-specific climate finance reaching those countries totals perhaps $500 to $700 million annually, representing 2% of adaptation funding and 0.5% of multilateral climate finance. “With regards to finance, that reality is that we have a deficit that is quite colossal,” said Carlos Lopes, Special Envoy for Africa to the COP30 Presidency. A WHO survey of National Health Adaptation Plans found all included climate-health risks. But just 28 nations worldwide have completed such plans. As temperatures continue rising and extreme weather events intensify, pressure mounts for health system adaptation at a moment when global health financing faces unprecedented strain. Overall development assistance for health dropped 21% from nearly $50 billion in 2024 to $39 billion in 2025, driven largely by US withdrawal from global health programs. The WHO itself faces budget shortfalls of 15-20%. Climate-health financing has grown from less than $1 billion globally in 2018 to $7.1 billion in 2022, the only aid sector to grow in that time apart from education, according to Rockefeller Foundation analysis. But substantial portions arrive as loans: 24% of bilateral climate-health funding and more than 90% from the Asian Development Bank and Inter-American Development Bank. Many developing countries now spend more on servicing debt than on healthcare, with low-income countries spending roughly 300 times less per capita on health than wealthy nations. That finance shortfall impacts their ability to implement adaptation plans like the Belem Framework: A 2021 WHO survey found that while half of the countries reported having national health-climate strategies, less than a quarter achieved high implementation levels. Insufficient financing was identified as the key barrier by 70% of responding countries. Health’s struggles mirror wider climate adaptation finance gaps. At COP26 in 2021, developed countries pledged to triple overall adaptation finance from 2019 levels to at least $120 billion per year by 2025. Actual flows across all sectors totalled $26 billion in 2023. Money will determine whether Belém becomes an implemented plan or another symbolic declaration. Without tens of billions in annual funding, it will likely follow previous COP health commitments that failed to translate rhetoric into action. “The Belém Health Action Plan gives us the blueprint,” said Simon Stiell, executive secretary of the UN Framework Convention on Climate Change. “What we need now is sustained, coordinated and well-financed action to turn its promises into protection for all.” What’s the plan? Launch event for the Belem Health Action Plan at COP30. The Belém plan functions as a framework of best practice recommendations for adapting health systems to the climate crisis, containing no legally binding requirements or targets. Instead, the document outlines recommendations organized around surveillance systems, policy interventions, and infrastructure overhauls that officials say are essential to protecting billions from climate-driven health crises. The one specific requirement: Countries that endorse it will report progress through the Paris Agreement’s Global Stocktake by COP33 in 2028, with no enforcement mechanisms or compliance requirements. “For decades, WHO has been calling for action to adapt health systems and build resilience to climate change,” said Tedros Adhanom Ghebreyesus, WHO director-general. “The Belém health action plan is how we can do that.” “Health systems themselves are affected by climate change, compromising their ability to deliver life-saving care when people need it most,” he said. “There can be no healthy people on a sick planet.” The first focus: building the capacity to see threats coming. The framework calls for climate-informed health monitoring that links meteorological agencies with health institutions, using predictive modelling to trigger early warnings before heat waves, floods, or disease outbreaks overwhelm communities. Surveillance should also track which populations face the greatest risks, data officials say is often missing. The second area addresses policy interventions to protect communities, including clean energy and sustainable transport, heat protection for workers, mental health support woven into climate response, and targeted measures for Indigenous peoples and persons with disabilities. ”For many countries, adaptation is a question of survival in the short run. If you don’t adapt, it threatens the coverage of health services of patients and professionals who are already facing adverse conditions,” Padhila said. “If we don’t adapt, we are going to increase inequality. In short, if you don’t adapt, we will kill people.” Water & power “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. Finance will determine whether the Belém framework’s most ambitious element, climate-resilient infrastructure, can be delivered. The plan envisions health facilities built to withstand climate shocks, renewable energy powering clinics, telehealth platforms extending care, and strategic stockpiles of temperature-stable medicines and vaccines. It calls for “integrated methodologies linking environmental, meteorological, social, climate and health monitoring data” with real-time surveillance and digital technologies as “structural components.” The problem: roughly 100,000 health facilities in sub-Saharan Africa lack reliable electricity, affecting nearly a billion people worldwide. Up to 70% of medical equipment in developing countries sits unused due to power failures. Cold chains for vaccines, digital surveillance systems, early warning platforms, and telehealth services all depend on reliable power that serving populations don’t have. Closing the healthcare electrification gap by 2030 would cost $4.9 billion, about $5 per person affected over six years. That’s less than one year of current global climate-health spending. “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. “It is very important we have the policies… working on the value chains of electricity to make sure that our babies, who are getting born without electricity,” have access to care. Water and sanitation infrastructure are equally critical, she noted. “If we bring water, we bring sanitation. There is already a disease that we will put away. We can tell our boys and girls to wash their hands, but how could they do it if there is no water at the school?” Just three nations have completed all four ATACH assessments as of 2025. The Belém plan’s success will depend not just on building infrastructure, but on countries’ ability to track and report progress. WHO will measure implementation through ATACH, its Alliance for Transformative Action on Climate and Health, which already requires members to complete vulnerability studies, adaptation plans, emissions inventories, and decarbonization roadmaps. The record so far suggests those demands exceed many countries’ capacity. Four years after ATACH’s launch in 2021, only three countries—France, Japan, and the UK—have completed all four assessments. Across 88 countries with available data, roughly 35-40% completed vulnerability assessments and 30% finished adaptation plans. In Africa, fewer than 10 of 29 ATACH members have completed vulnerability assessments. The Belém plan now adds reporting requirements on top of those existing gaps: tracking mental health impacts, monitoring workers’ heat exposure, establishing community resilience programmes, and climate-proofing supply chains, all by 2028. That creates an impossible bind. France, Japan, and the UK have the technical capacity and resources to meet these demands. Many other countries lack not only the expertise for complex reporting systems, but the basic infrastructure, electricity and water, that the plan assumes as a foundation. “Finance is still the bottleneck for us,” Princess Djigma said. Fossil fuel phase-out excluded Delegates arrive for the opening day of COP30 on the edge of the Brazilian Amazon. Notably absent from the plan is any reference to phasing out fossil fuels, the main driver of climate change and the resulting heat, extreme weather and air pollution killing approximately 8m people annually from respiratory and cardiovascular diseases. The omission came at the explicit instruction of the Brazilian COP30 presidency, according to people familiar with the negotiations. The exclusion comes as the International Energy Agency warned Wednesday that global oil and gas demand will rise for the next 25 years if countries do not change course. Until this year, all of the Paris-based body’s modelling assumed fossil fuel consumption would peak this decade. “Climate change is declining — and declining rapidly — in the international energy policy agenda,” said Fatih Birol, the IEA’s executive director. “And this is happening while 2024 was the hottest year in history.” Fifteen countries allocated more resources to fossil fuel net subsidies than their entire national health budgets. Birol’s findings align with the Lancet Countdown report published ahead of the summit, which found the 100 largest oil and gas companies have production strategies that put them on track to exceed their share of production consistent with 1.5 °C of heating by 189% in 2040, up from 183% in March 2024. Private bank lending to fossil fuel activities surged 29% to $611 billion in 2024, exceeding green sector lending by 15%. Some 73 of 87 countries reviewed provided net explicit fossil fuel subsidies in 2023, allocating nearly $1 trillion in direct support. Including indirect subsidies, that figure rises to over $7tn, according to the International Monetary Fund — more than governments spend annually on education and about two-thirds of what they spend on healthcare. The declining political attention extends to international engagement: Mentions of health and climate change by governments in their annual UN General Assembly statements declined from 62% in 2021 to 30% in 2024, according to the Lancet Countdown. “Record deaths from climate-driven wildfires in 2023 show that there’s no adaptation without mitigation,” said Nina Renshaw, head of health at the Clean Air Fund. “Ministries of Health and Finance won’t be able to bail hospitals and clinics out of the climate emergency if governments don’t stop the emissions which are already causing unprecedented harm.” ‘More than dialogue’ Delegates convened for the first-ever Health Day at a UN climate summit in Dubai. The Belém plan follows a pattern established at recent climate summits: the COP28 Dubai Health Declaration signed by 143 countries, the Baku Coalition for Climate and Health launched last year, and efforts stretching back to Glasgow in 2021. Like those efforts, Belém is a non-binding, voluntary process taking place outside formal UN negotiations. Criticisms of the outcomes of Dubai and Baku describe their outcomes as symbolic gestures that generate attention but fail to secure funding, sustained commitment, or implementation. Officials on Thursday repeatedly stressed the need to break the holding pattern. “This gathering must be more than dialogue,” said Jarbas Barbosa, director of the Pan American Health Organization. “It must galvanise collective action and inspire new policies dedicated to protecting everyone’s health from the worsening effects of climate change.” “The climatic crisis is fundamentally a health crisis,” Barbosa said. “We are not talking any more about distant or possible threats. Climate change is a present and growing reality.” Whether the Belém framework can overcome the obstacles that have stymied previous declarations — insufficient financing, limited technical capacity, competing priorities — remains uncertain. But Padilha argued the world has no choice but to try. “We are faced with a dilemma: we either continue to speak and speak and talk, or we can walk the walk and make the political commitment to do so,” he said. “We cannot accept the erosion of multilateralism in global health. Those who deny multilateralism are surrounding us. We will not listen to them.” Image Credits: COP30, COP30, COP30, COP30, COP30, COP30, WHO . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Former DOGE Official Driving US Bilateral Health Agreements With African Countries 17/11/2025 Kerry Cullinan US official Brad Smith (right) at a meeting to discuss a bilateral agreement with Kenyan Treasury and health officials. The United States government is moving rapidly to secure Memorandums of Understanding (MOU) with African countries that offer limited health aid for five years in exchange for 25 years’ access to countries’ data about “pathogens with epidemic potential”. Some commentators have described the terms of the bilateral MOUs as “extractive” as they fail to offer African countries access to the health products that might be developed from the pathogen material that they share. The process is being driven by Brad Smith, formerly one of the leaders of Elon Musk’s Department of Government Efficiency (DOGE), who was responsible for implementing deep cuts to the US Health and Human Services (HHS) department. Smith is now a global health advisor in the US State Department, overseeing the reorganisation of the US President’s Emergency Plan for AIDS Relief (PEPFAR) and health grants from the now defunct US Agency for International Development (USAID). He was part of the US delegation that met Kenyan health and finance officials last week to discuss its MOU. So too was Bethany Kozma, a former USAID official during the first Trump administration and a fervent anti-abortion campaigner. She is currently chief advisor for policy and strategy in the HHS Global Affairs Office. Bethany Kozma, anti-abortion campaigner and chief advisor for policy and strategy in the HHS Global Affairs Office, also attended the meeting with Kenya. Dr Chris Kiptoo, Kenyan Treasury’s Principal Secretary, reported after last week’s meeting that “both countries are finalising a bilateral agreement that aligns Kenya’s health priorities with the United States’ global health objectives, strengthening a partnership that saves lives and builds a more resilient health system for our nation”. Meanwhile, Rwandan Health Minister Dr Sabin Nsanzimana met a US delegation headed by Dr Mamadi Yilla, US State Department deputy assistant secretary for health diplomacy, last week to discuss a new MOU. Rwandan Health Minister Dr Sabin Nsanzimana and Dr Mamadi Yilla, US deputy assistant secretary for global health diplomacy and other officials. Smith also led the US delegation to Zambia on Monday (17 November), where he met Zambia’s Health Minister, Dr Elijah Muchima, and Finance Minister Situmbeko Musokotwane. The meeting aimed to “chart a new course for US health assistance to Zambia”, according to the US Embassy in Zambia. “The new approach envisions both governments committing to funding levels and health outcome performance objectives in order to accelerate the transition from an aid-dependent health sector to a Zambian government-led health system that is able to sustainably meet the health needs of the Zambian people,” according to the US media release. US official Brad Smith and Zambian Finance Minister Situmbeko Musokotwane. Extensive access to data The MOUs include clauses that would give the US extensive access to country health databases and contain punitive measures for countries that fail to provide this access or pathogen information, including unspecified “changes in the planned assistance” or total discontinuation of aid. Conversely, those that meet targets may get unspecified rewards. While the agreements contain a list of targets (“outcome metrics) for reducing HIV, TB, malaria, maternal and under-five mortality, and increasing measles vaccinations, details about how these will be achieved are scanty. In contrast to the health services section, the “surveillance and outbreak response” section is far more detailed, with budget allocations and staff numbers. For instance, Zambia is expected to employ “1,723 field epidemiologists” in 2026 at its own expense to meet its outbreak surveillance and pathogen-sharing requirements, according to a draft seen by Health Policy Watch. The US also notes in the draft Zambian MOU that it is making a $50 million cut to its previous commitment of $120 million in funding for antiretroviral (ARV) medicine and HIV tests due to “historic theft”. This relates to a 2021 scandal where it emerged that ARVs donated to Zambia were being sold in pharmacies. Countries need the capacity to detect disease outbreaks within seven days and report to the US on these within a day of an outbreak being detected, according to the MOUs. Twenty-five years’ access for five-year grants Countries also have to commit to signing a 25-year “specimen sharing agreement”, although the MOUs only cover a five-year grant period. This agreement will cover “sharing physical specimens and related data, including genetic sequence data, of detected pathogens with epidemic potential for either country within five days of detection”. However, an annex that is supposed to set out the “elements” of the agreement is blank. Bizarrely, the MOUs also want governments to commit to a 25-year “data sharing arrangement” for “exchanging data on the long-term performance of this MOU and for accountability to the United States Congress for appropriated funds”. However, the country grants will only run from 1 April 2026 until 2030. Author Emily Bass published a template for this data-sharing arrangement over the weekend, saying that it “reveals the unprecedentedly extractive nature of these ongoing negotiations”. The US wants access to a range of data, including electronic medical records, health management and information systems, and outbreak response and surveillance data systems. “This agreement affords the US at-will visibility into digital systems, including those, like electronic medical records, that include personal identifiable information,” Bass notes. In the audit section, the MOUs stress that countries need to provide the US with “any data access or information needed to monitor compliance with applicable legal requirements, including to confirm no US government funding is being used for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortions”. The MOU concludes by noting that it is not a legally binding document but “a record of the intentions of the parties”. Bypassing WHO? Member states started to negotiate a pathogen access and benefit-sharing system at the WHO headquarters in Geneva recently. By placing itself at the centre of rapid information-sharing about dangerous pathogens, the US appears to be attempting to usurp the World Health Organization (WHO). WHO member states are currently negotiating a Pathogen Access and Benefit Sharing (PABS) system that unite countries, pharmaceutical companies and non-profits in a single process aimed at speedily sharing information and developing counter-measures for pathogens that can cause pandemics. The US and Argentina are the only countries that have opted out of these negotiations. However, if the US is the gatekeeper of pathogen information via these MOUs, this likely to fracture and slow down the global response to pandemics. In addition, US companies could also get the first shot at developing vaccines, therapeutics and diagnostics for these pathogens. Aggrey Aluso of Resilience Action Network Africa (RANA) warned that while governments “should explore deals that could benefit the lives of their people and their economy, such deals should not be extractive”. “Global health security cannot be built on coercive conditionalities,” Aluso told Health Policy Watch. “True preparedness demands equity, respects data sovereignty, and is grounded in solidarity — not transactions that deepen inequities and silence the voices of those most affected. The current version of the proposed MOUs need an inclusive, equity-centred approach.” Health Systems Are Unprepared for The Climate Crisis 14/11/2025 Stefan Anderson The synthesis report follows the launch of the Belém Health Action Plan at COP30, a voluntary best practice framework to assist governments in adapting their health systems for climate change. Nations worldwide must finance and implement climate adaptation measures for health systems or risk losing millions of lives as extreme weather, rising temperatures, and intensifying heat threaten healthcare access for nearly half the global population, according to a report published Friday by the World Health Organization and Brazil. The special report, released at the COP30 summit in Belém, follows Thursday’s launch of the Belém Health Action Plan, which won backing from roughly two dozen countries but secured no financial commitments from governments. The only funding to support the plan came from philanthropies: a $300 million one-time grant. The report estimates health system adaptation needs at $22 billion per year by 2035. “The climate crisis is a health crisis – not in the distant future, but here and now,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This special report provides evidence on the impact of climate change on individuals and health systems, and real-world examples of what countries can do – and are doing – to protect health and strengthen health systems.” The past decade has been the hottest on record, with global temperatures exceeding 1.5°C above pre-industrial levels for the first time in 2024. Updated Climate Tracker projections published at the UN climate summit on Wednesday show the world on track for 2.5°C of warming, while the UN Environment Programme projected last week that a business-as-usual scenario has the world heading for 2.8°C. Every fraction of a degree endangers millions. “Many health systems are fragile, lacking climate-trained personnel, resilient infrastructure and adequate surveillance,” said Simon Stiell, executive secretary of the UN Framework Convention on Climate Change. “Watching super typhoons and flash floods rip through hospitals and local health clinics is heartbreaking, but lamenting is not a strategy. We need real solutions.” Simon Still, executive secretary of the UNFCCC, addresses COP30’s opening plenary. “The real challenges people face, such as extreme heat, air pollution, infectious diseases, mental health and food insecurity – humanity can only win this global climate fight if we connect stronger climate actions to people’s top priorities in their daily lives, and there are few higher priorities than our health,” Stiell said. The report does not present new evidence, functioning instead as a synthesis of the best available science and data on the risks posed to unprepared health systems by climate change, drawing on academic literature, government and UN reports, and real-world case studies. “Recent tragedies show that now is the time to implement policies and actions that address the impacts of climate change on health,” said Alexandre Padilha, Brazil’s health minister. “The Belém Health Action Plan and this report offer countries the tools they need to turn scientific evidence into concrete action.” As storms batter coastlines, floods displace communities, and droughts fuel conflict and hunger, the report paints a picture of health systems under mounting strain. The familiar but alarming statistics form the case to policymakers to invest in adaptation and join the Belém plan. More than 540,000 people now die annually from extreme heat, a 63% rise since the 1990s. Between 3.3 and 3.6 billion people live in regions highly vulnerable to climate change. One in twelve of the world’s 200,000 hospitals face the risk of total shutdown due to extreme weather events under high-emissions scenarios, with more than 70% of at-risk facilities located in low- and middle-income countries. Hospitals and health facilities are also 41% more likely to suffer damage from extreme weather events than in 1990. “Climate change is an unavoidable reality that challenges public health and adds pressure on already overwhelmed systems,” Padilha said, calling policies to protect the health sector one of the “most strategic decisions of the 21st century.” “Protecting lives, reducing inequalities, and bolstering the resilience of health systems are no longer just goals – they have become ethical and democratic imperatives,” he said. Mitigation left out of the main Belém text Brazil’s COP30 presidency chose the Amazon city of Belém in an effort to remind negotiators of the planet they are fighting to protect. While the report and Belém Health Action Plan focus on preparing health systems for climate impacts, the synthesis document draws a clear conclusion about what would most protect those systems: cutting emissions. “The evidence is clear: urgent and sustained mitigation across all sectors is the single most important health adaptation intervention,” states the executive summary. “There are profound physical, financial, and technological limits to adaptation, and health systems cannot remain resilient in a world of unchecked warming.” By reducing emissions, health systems would face less extreme weather events, fewer heat deaths, and smaller disease burdens, making adaptation needs less severe in the first place. That finding sits awkwardly with the Belém Health Action Plan itself, which contains no references to phasing out fossil fuels, the main driver of climate change. The fossil fuel omission came at the explicit instruction of the Brazilian COP30 presidency, according to people familiar with the negotiations, likely to open the door for more nations to sign on who will not commit to language on fossil fuel phase-out. What the report identifies as “the most effective measure” to protect health systems is excluded from the political Belém framework, which requires endorsement from governments, instead relegated to a supporting document with no political weight. “When COP30 delegates leave Belém, success will be measured by the courage governments have demonstrated to act on what is already known: that fossil fuels are destroying people’s health,” said Jeni Miller, health lead at the Global Climate and Health Alliance. “To ignore these realities would be to betray both science and humanity.” A $20 billion gap Adaptation needs for health systems estimated in the COP30 special report. Direct health sector adaptation interventions will require more than $22 billion annually by 2035, according to the report, approximately 7% of total adaptation financing needs in climate-vulnerable countries. Current health-specific climate finance reaching those countries totals around $500 to $700 million annually, representing 2% of adaptation funding and 0.5% of multilateral climate finance. Climate and health finance has grown considerably in recent years, rising tenfold from less than $1 billion in 2018 to $7.1 billion in commitments between 2018 and 2022, according to analysis published earlier this year by the Rockefeller Foundation, WHO and other partners. In 2022, this included $4.8 billion from bilateral donors, $600 million from multilateral development banks, $1.5 billion from multilateral health funds, and $130 million from philanthropies. The share of climate finance targeting the health sector increased from 1% in 2018 to 9% in 2022, the only sector apart from education to see an increase. Yet these flows remain far below estimated needs, and more than 90% of health adaptation funding from development banks arrives as loans rather than grants. “The evidence is clear that we have been too slow to act on climate change and we are now ill-equipped to cope with rising temperatures across the world,” said Alan Dangour, health and climate lead at the Wellcome Trust. The report identifies persistent gaps in readiness. Only 54% of national health adaptation plans assess risks to health facilities. Fewer than 30% of health adaptation studies consider income, 20% consider gender, and less than 1% include people with disabilities. More than 60% of National Adaptation Plans have no formal tracking or evaluation in place. “Extreme heat, air pollution and infectious disease all hit the most vulnerable hardest: children, pregnant people, older adults, outdoor workers, and communities with the fewest resources,” Dangour said. “At COP30 and beyond, governments must act on the science – cut emissions, invest in adaptation, and put health at the heart of climate action. Lives, economies, and our future depend on the solutions we deliver now.” Image Credits: COP30, COP30. How Intimate Partner Violence Affects Children 14/11/2025 Disha Shetty Children’s health suffers in households where their mothers are abused. Noma Bolani has a clear memory of her abusive father stopping the car in the middle of the highway in Durban, South Africa and asking her mother to get out. She was just six years old, but Bolani followed her mother out of the car, and together they sought help from a passing motorist. Bolani is now 38, and has anxiety stemming from early childhood experiences related to growing up with an abusive father and witnessing her mother being at the receiving end of emotional and financial violence. Ayesha*, 34, from New Delhi, India, grew up watching her mother being subjected to physical, emotional and financial violence from her father. He would sometimes also resort to silent treatment that would last weeks, refuse to pay school fees for Ayesha and her sister and resort to physical violence using belts, shoes and, at times, utensils. Ayesha suffers from Polycystic Ovary Disease (PCOD) that affects the regularity of her periods and causes hormonal changes. Her doctor believes the stress she was subjected to as a child played a significant role in worsening her PCOD. Like Bolani, Ayesha also carries mental health scars from watching violence directed at her mother. When mothers are at the receiving end of violence, it can make their children physically ill, according to a growing body of research. Impact on children’s health Health data from 37 countries in sub-Saharan Africa found that children under the age of five whose mothers experienced intimate partner violence (IPV) were more likely to develop diarrhoeal disease and symptoms of acute respiratory infections, according to a study published in The Lancet last year. It called for tailored interventions to address childhood morbidity and mortality attributed to IPV in “priority countries” – Burkina Faso, Burundi, Chad, Comoros, Gabon, Liberia, Nigeria, Sierra Leone, South Africa, and Uganda. “The most important thing is actually the cumulative effect,” said Abel Dadi, lead author and a social epidemiologist at the Menzies School of Health Research at the Charles Darwin University in Australia. His study looked at exposure to three kinds of violence – physical, sexual and emotional. “When they come together, their effect increases,” he said. Dadi’s team also found a strong link between IPV and stunting in Burundi, and IPV and children being underweight in Burkina Faso, although the results were not consistent across all countries. What is not yet clear is the exact pathway of how IPV directed towards the mother affects a child’s physical health. A mother and newborn at a health center in the Patna district of Bihar, India. Babies’ health and well-being is deeply affected by their mother’s health. Pervasive violence The World Health Organization (WHO) recognizes that violence against women is a major public health issue. Globally, one third (27%) of women experience IPV in their lifetime, according to WHO figures. In sub-Saharan Africa, these rates are even higher, with 45·6% of women experiencing IPV in their lifetime. Young women aged 15 to 19 are the most affected by IPV. By the time they are 19 years old, almost a quarter of adolescent girls (24%) who have been in a relationship have already been physically, sexually, or psychologically abused by a partner, according to WHO data. However, while it is widely accepted that intimate partner violence affects a woman’s mental, physical and sexual health at risk, its impact on children has not received the same attention. But a child’s health and well-being are completely dependent on their mother during pregnancy, and heavily dependent in the early years, so a mother’s health and well-being directly affects her child’s health. The WHO, which developed a toolkit with UN Women to prevent violence against women in 2019, acknowledges that violence against women and against children often occurs in the same household. Psychiatrists like Bessel van der Kolk, who wrote ‘The Body Keeps the Score’, and Gabor Mate, author of ‘The Myth of Normal’, have also brought the lifelong impact of childhood trauma into the public domain, particularly of growing up with abusive parents. But IPV has long been seen as a criminal issue rather than a health issue. In India, for example, hospitals have only recently started to offer health workers training to see it as a public health problem. “I don’t think it is a well-understood field of work in terms of a response from the courts or from the state’s response to children’s rights,” said Julie Thekkudan, South Asia consultant at Equality Now, a global non-profit that advocates for women’s and girls’ rights. Each dot represents a different country in the region. There has been progress, with signs that IPV is reducing in some low- and middle-income countries due to progress in women’s empowerment. The reason women find it hard to leave abusive relationships, especially in the Global South, is that they have been socialized to tolerate violence, according to Thekkudan. In societies that favour sons and devalue daughters, girls are socialized into believing that their “purpose in life is to get married”, she explained. Staying in a marriage, even if it is abusive, and seen as part of “making sure that your family honor is maintained”, Thekkudan added. That, in addition to the fact that women don’t always have the financial ability to leave, makes it a harder choice. Dadi said that any intervention design on maternal health should consider intimate partner violence as well as the mental health of the mother. Currently, most of these kinds of interventions are concentrated in high-income countries, according to research. On average, countries that do better on gender equity indexes usually also experienc lower levels of violence against women, according to takeaways published in The Lancet. But a woman’s higher economic status can also make her vulnerable. One study from sub-Saharan Africa showed that women’s employment, especially if they were the sole earners or if they earned more than their male partner, was linked to a higher level of intimate partner violence. Any solution “has to be a multi-pronged, multi-level”, said Thekkudan. “I don’t think there is one solution that will change the entire system or the structure.” *Name changed to protect identity Image Credits: Photo by Alex Pasarelu on Unsplash, BMGF, World Bank. Brazil Wins Limited Backing for COP30 Climate-Health Plan, But Nations Commit No Finance 13/11/2025 Stefan Anderson Belém framework wins backing from two dozen nations, but health remains outside formal UN climate negotiations. Brazil launched a sweeping climate-health action plan on Thursday, named after the COP30 host city in the Amazon, winning initial endorsements from roughly two dozen countries for a voluntary framework calling on nations to strengthen disease surveillance, build climate-resilient infrastructure, and protect vulnerable populations from the health impacts of rising temperatures and extreme weather. The Belém Health Action Plan outlines 60 action items across surveillance systems, evidence-based policies, and health innovation to address the health risks facing 3.3 billion people globally affected by the climate crisis. “The climate crisis is one of the most significant health challenges of our time,” states the plan, developed by Brazil’s health ministry in consultation with the WHO. Countries that endorse the voluntary framework will report their progress through UN climate negotiations during the second Global Stocktake at COP33 in 2028. The World Health Organization calls climate change “the greatest single risk to humanity,” and the World Bank estimates it could cause up to 15.6 million deaths between 2026 and 2050, with health impacts costing $8.6 to $15.4 trillion by mid-century. Initial supporters include European Union states such as France and Spain, small island nations like Tuvalu, African countries from Congo to Zambia, and others including Canada, Japan, the United Kingdom and Malaysia. Brazil’s health minister Alexandre Padilha said the plan had received backing from more than 80 nations and institutions, though the vast majority comprises civil society organisations like the Global Climate and Health Alliance, global health actors including Medicines for Malaria Venture and Drugs for Neglected Diseases Initiative, and UN agencies such as UNFPA, UNICEF and UNITAID. “We expect to have more by the end of the day and the end of the COP,” Padilha said, adding the presidency would continue “trying to engage and mobilise” more countries. “There’s a very strong commitment from our government and ministers of health in this plan.” Delegates gather in the plenary hall of COP30 in Belem for the launch of the Brazil-WHO-led health-climate adaptation plan. The voluntary nature of the framework and broad support for the Alliance for Transformative Action on Climate and Health (ATACH) — a WHO-led initiative launched at COP26, which now counts 101 members — suggest endorsements will likely grow, but implementation remains uncertain. WHO will serve as the secretariat for the Belém plan, measuring outcomes through the ATACH framework. The sole explicit dissent Thursday came from Egypt, part of the Baku coalition of previous COP presidencies that helped draft the plan. Egypt’s health minister expressed willingness to join but voiced “concern about the reference to the inclusion of LGBTIQ+ individuals, as such patterns fall outside the nationally recognised policy frameworks in the cultural context of Egypt.” Other coalition members, the United Arab Emirates and Azerbaijan, expressed political will to continue discussions but stopped short of endorsement, instead noting they had “contributed” and “noted with interest” the framework’s goals. “We have to look at the impact of climate change, one of the main threats to public health in the world today,” Padilha said. “Scientific evidence has shown clearly that the climate crisis is first and foremost a crisis of public health throughout the world.” “The time of warnings has finished. Now we are living in a time of consequences,” he added. “The climate has already changed, so we have no alternative but to have public policies to adapt and face climate change.” No money from nations The voluntary adaptation framework was endorsed by around countries but faces billions in funding shortfalls. The launch came with no new financial commitments from endorsing nations. The sole funding announcement came from a coalition of philanthropies including the Gates Foundation, Wellcome Trust, and Rockefeller Foundation: a $300m one-time grant to support climate-health adaptation measures. That figure is dwarfed by estimates that low- and middle-income countries require at least $11 billion annually just for basic health adaptation covering only disease control for malaria, dengue, diarrheal diseases, heat-related mortality, and essential surveillance improvements, according to the UN Environment Programme. “Health systems, already stretched and underfunded, are struggling to cope with these growing pressures, and most are still unprepared for what is coming,” said Marina Romanello, executive director of the Lancet Countdown at University College London. “Existing finance falls short by billions. Without urgent investment, we will not be able to protect populations from escalating climate impacts.” The $11 billion annual UNEP pricetag excludes respiratory illnesses, malnutrition, mental health services, additional infectious disease programs, workers’ health protection, supply chain adaptation, and health system decarbonisation — most of what the Belém plan contains. The UNFCCC estimates global health adaptation will require $26.8 to 29.4 billion annually by 2050. Current health-specific climate finance reaching those countries totals perhaps $500 to $700 million annually, representing 2% of adaptation funding and 0.5% of multilateral climate finance. “With regards to finance, that reality is that we have a deficit that is quite colossal,” said Carlos Lopes, Special Envoy for Africa to the COP30 Presidency. A WHO survey of National Health Adaptation Plans found all included climate-health risks. But just 28 nations worldwide have completed such plans. As temperatures continue rising and extreme weather events intensify, pressure mounts for health system adaptation at a moment when global health financing faces unprecedented strain. Overall development assistance for health dropped 21% from nearly $50 billion in 2024 to $39 billion in 2025, driven largely by US withdrawal from global health programs. The WHO itself faces budget shortfalls of 15-20%. Climate-health financing has grown from less than $1 billion globally in 2018 to $7.1 billion in 2022, the only aid sector to grow in that time apart from education, according to Rockefeller Foundation analysis. But substantial portions arrive as loans: 24% of bilateral climate-health funding and more than 90% from the Asian Development Bank and Inter-American Development Bank. Many developing countries now spend more on servicing debt than on healthcare, with low-income countries spending roughly 300 times less per capita on health than wealthy nations. That finance shortfall impacts their ability to implement adaptation plans like the Belem Framework: A 2021 WHO survey found that while half of the countries reported having national health-climate strategies, less than a quarter achieved high implementation levels. Insufficient financing was identified as the key barrier by 70% of responding countries. Health’s struggles mirror wider climate adaptation finance gaps. At COP26 in 2021, developed countries pledged to triple overall adaptation finance from 2019 levels to at least $120 billion per year by 2025. Actual flows across all sectors totalled $26 billion in 2023. Money will determine whether Belém becomes an implemented plan or another symbolic declaration. Without tens of billions in annual funding, it will likely follow previous COP health commitments that failed to translate rhetoric into action. “The Belém Health Action Plan gives us the blueprint,” said Simon Stiell, executive secretary of the UN Framework Convention on Climate Change. “What we need now is sustained, coordinated and well-financed action to turn its promises into protection for all.” What’s the plan? Launch event for the Belem Health Action Plan at COP30. The Belém plan functions as a framework of best practice recommendations for adapting health systems to the climate crisis, containing no legally binding requirements or targets. Instead, the document outlines recommendations organized around surveillance systems, policy interventions, and infrastructure overhauls that officials say are essential to protecting billions from climate-driven health crises. The one specific requirement: Countries that endorse it will report progress through the Paris Agreement’s Global Stocktake by COP33 in 2028, with no enforcement mechanisms or compliance requirements. “For decades, WHO has been calling for action to adapt health systems and build resilience to climate change,” said Tedros Adhanom Ghebreyesus, WHO director-general. “The Belém health action plan is how we can do that.” “Health systems themselves are affected by climate change, compromising their ability to deliver life-saving care when people need it most,” he said. “There can be no healthy people on a sick planet.” The first focus: building the capacity to see threats coming. The framework calls for climate-informed health monitoring that links meteorological agencies with health institutions, using predictive modelling to trigger early warnings before heat waves, floods, or disease outbreaks overwhelm communities. Surveillance should also track which populations face the greatest risks, data officials say is often missing. The second area addresses policy interventions to protect communities, including clean energy and sustainable transport, heat protection for workers, mental health support woven into climate response, and targeted measures for Indigenous peoples and persons with disabilities. ”For many countries, adaptation is a question of survival in the short run. If you don’t adapt, it threatens the coverage of health services of patients and professionals who are already facing adverse conditions,” Padhila said. “If we don’t adapt, we are going to increase inequality. In short, if you don’t adapt, we will kill people.” Water & power “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. Finance will determine whether the Belém framework’s most ambitious element, climate-resilient infrastructure, can be delivered. The plan envisions health facilities built to withstand climate shocks, renewable energy powering clinics, telehealth platforms extending care, and strategic stockpiles of temperature-stable medicines and vaccines. It calls for “integrated methodologies linking environmental, meteorological, social, climate and health monitoring data” with real-time surveillance and digital technologies as “structural components.” The problem: roughly 100,000 health facilities in sub-Saharan Africa lack reliable electricity, affecting nearly a billion people worldwide. Up to 70% of medical equipment in developing countries sits unused due to power failures. Cold chains for vaccines, digital surveillance systems, early warning platforms, and telehealth services all depend on reliable power that serving populations don’t have. Closing the healthcare electrification gap by 2030 would cost $4.9 billion, about $5 per person affected over six years. That’s less than one year of current global climate-health spending. “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. “It is very important we have the policies… working on the value chains of electricity to make sure that our babies, who are getting born without electricity,” have access to care. Water and sanitation infrastructure are equally critical, she noted. “If we bring water, we bring sanitation. There is already a disease that we will put away. We can tell our boys and girls to wash their hands, but how could they do it if there is no water at the school?” Just three nations have completed all four ATACH assessments as of 2025. The Belém plan’s success will depend not just on building infrastructure, but on countries’ ability to track and report progress. WHO will measure implementation through ATACH, its Alliance for Transformative Action on Climate and Health, which already requires members to complete vulnerability studies, adaptation plans, emissions inventories, and decarbonization roadmaps. The record so far suggests those demands exceed many countries’ capacity. Four years after ATACH’s launch in 2021, only three countries—France, Japan, and the UK—have completed all four assessments. Across 88 countries with available data, roughly 35-40% completed vulnerability assessments and 30% finished adaptation plans. In Africa, fewer than 10 of 29 ATACH members have completed vulnerability assessments. The Belém plan now adds reporting requirements on top of those existing gaps: tracking mental health impacts, monitoring workers’ heat exposure, establishing community resilience programmes, and climate-proofing supply chains, all by 2028. That creates an impossible bind. France, Japan, and the UK have the technical capacity and resources to meet these demands. Many other countries lack not only the expertise for complex reporting systems, but the basic infrastructure, electricity and water, that the plan assumes as a foundation. “Finance is still the bottleneck for us,” Princess Djigma said. Fossil fuel phase-out excluded Delegates arrive for the opening day of COP30 on the edge of the Brazilian Amazon. Notably absent from the plan is any reference to phasing out fossil fuels, the main driver of climate change and the resulting heat, extreme weather and air pollution killing approximately 8m people annually from respiratory and cardiovascular diseases. The omission came at the explicit instruction of the Brazilian COP30 presidency, according to people familiar with the negotiations. The exclusion comes as the International Energy Agency warned Wednesday that global oil and gas demand will rise for the next 25 years if countries do not change course. Until this year, all of the Paris-based body’s modelling assumed fossil fuel consumption would peak this decade. “Climate change is declining — and declining rapidly — in the international energy policy agenda,” said Fatih Birol, the IEA’s executive director. “And this is happening while 2024 was the hottest year in history.” Fifteen countries allocated more resources to fossil fuel net subsidies than their entire national health budgets. Birol’s findings align with the Lancet Countdown report published ahead of the summit, which found the 100 largest oil and gas companies have production strategies that put them on track to exceed their share of production consistent with 1.5 °C of heating by 189% in 2040, up from 183% in March 2024. Private bank lending to fossil fuel activities surged 29% to $611 billion in 2024, exceeding green sector lending by 15%. Some 73 of 87 countries reviewed provided net explicit fossil fuel subsidies in 2023, allocating nearly $1 trillion in direct support. Including indirect subsidies, that figure rises to over $7tn, according to the International Monetary Fund — more than governments spend annually on education and about two-thirds of what they spend on healthcare. The declining political attention extends to international engagement: Mentions of health and climate change by governments in their annual UN General Assembly statements declined from 62% in 2021 to 30% in 2024, according to the Lancet Countdown. “Record deaths from climate-driven wildfires in 2023 show that there’s no adaptation without mitigation,” said Nina Renshaw, head of health at the Clean Air Fund. “Ministries of Health and Finance won’t be able to bail hospitals and clinics out of the climate emergency if governments don’t stop the emissions which are already causing unprecedented harm.” ‘More than dialogue’ Delegates convened for the first-ever Health Day at a UN climate summit in Dubai. The Belém plan follows a pattern established at recent climate summits: the COP28 Dubai Health Declaration signed by 143 countries, the Baku Coalition for Climate and Health launched last year, and efforts stretching back to Glasgow in 2021. Like those efforts, Belém is a non-binding, voluntary process taking place outside formal UN negotiations. Criticisms of the outcomes of Dubai and Baku describe their outcomes as symbolic gestures that generate attention but fail to secure funding, sustained commitment, or implementation. Officials on Thursday repeatedly stressed the need to break the holding pattern. “This gathering must be more than dialogue,” said Jarbas Barbosa, director of the Pan American Health Organization. “It must galvanise collective action and inspire new policies dedicated to protecting everyone’s health from the worsening effects of climate change.” “The climatic crisis is fundamentally a health crisis,” Barbosa said. “We are not talking any more about distant or possible threats. Climate change is a present and growing reality.” Whether the Belém framework can overcome the obstacles that have stymied previous declarations — insufficient financing, limited technical capacity, competing priorities — remains uncertain. But Padilha argued the world has no choice but to try. “We are faced with a dilemma: we either continue to speak and speak and talk, or we can walk the walk and make the political commitment to do so,” he said. “We cannot accept the erosion of multilateralism in global health. Those who deny multilateralism are surrounding us. We will not listen to them.” Image Credits: COP30, COP30, COP30, COP30, COP30, COP30, WHO . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Health Systems Are Unprepared for The Climate Crisis 14/11/2025 Stefan Anderson The synthesis report follows the launch of the Belém Health Action Plan at COP30, a voluntary best practice framework to assist governments in adapting their health systems for climate change. Nations worldwide must finance and implement climate adaptation measures for health systems or risk losing millions of lives as extreme weather, rising temperatures, and intensifying heat threaten healthcare access for nearly half the global population, according to a report published Friday by the World Health Organization and Brazil. The special report, released at the COP30 summit in Belém, follows Thursday’s launch of the Belém Health Action Plan, which won backing from roughly two dozen countries but secured no financial commitments from governments. The only funding to support the plan came from philanthropies: a $300 million one-time grant. The report estimates health system adaptation needs at $22 billion per year by 2035. “The climate crisis is a health crisis – not in the distant future, but here and now,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This special report provides evidence on the impact of climate change on individuals and health systems, and real-world examples of what countries can do – and are doing – to protect health and strengthen health systems.” The past decade has been the hottest on record, with global temperatures exceeding 1.5°C above pre-industrial levels for the first time in 2024. Updated Climate Tracker projections published at the UN climate summit on Wednesday show the world on track for 2.5°C of warming, while the UN Environment Programme projected last week that a business-as-usual scenario has the world heading for 2.8°C. Every fraction of a degree endangers millions. “Many health systems are fragile, lacking climate-trained personnel, resilient infrastructure and adequate surveillance,” said Simon Stiell, executive secretary of the UN Framework Convention on Climate Change. “Watching super typhoons and flash floods rip through hospitals and local health clinics is heartbreaking, but lamenting is not a strategy. We need real solutions.” Simon Still, executive secretary of the UNFCCC, addresses COP30’s opening plenary. “The real challenges people face, such as extreme heat, air pollution, infectious diseases, mental health and food insecurity – humanity can only win this global climate fight if we connect stronger climate actions to people’s top priorities in their daily lives, and there are few higher priorities than our health,” Stiell said. The report does not present new evidence, functioning instead as a synthesis of the best available science and data on the risks posed to unprepared health systems by climate change, drawing on academic literature, government and UN reports, and real-world case studies. “Recent tragedies show that now is the time to implement policies and actions that address the impacts of climate change on health,” said Alexandre Padilha, Brazil’s health minister. “The Belém Health Action Plan and this report offer countries the tools they need to turn scientific evidence into concrete action.” As storms batter coastlines, floods displace communities, and droughts fuel conflict and hunger, the report paints a picture of health systems under mounting strain. The familiar but alarming statistics form the case to policymakers to invest in adaptation and join the Belém plan. More than 540,000 people now die annually from extreme heat, a 63% rise since the 1990s. Between 3.3 and 3.6 billion people live in regions highly vulnerable to climate change. One in twelve of the world’s 200,000 hospitals face the risk of total shutdown due to extreme weather events under high-emissions scenarios, with more than 70% of at-risk facilities located in low- and middle-income countries. Hospitals and health facilities are also 41% more likely to suffer damage from extreme weather events than in 1990. “Climate change is an unavoidable reality that challenges public health and adds pressure on already overwhelmed systems,” Padilha said, calling policies to protect the health sector one of the “most strategic decisions of the 21st century.” “Protecting lives, reducing inequalities, and bolstering the resilience of health systems are no longer just goals – they have become ethical and democratic imperatives,” he said. Mitigation left out of the main Belém text Brazil’s COP30 presidency chose the Amazon city of Belém in an effort to remind negotiators of the planet they are fighting to protect. While the report and Belém Health Action Plan focus on preparing health systems for climate impacts, the synthesis document draws a clear conclusion about what would most protect those systems: cutting emissions. “The evidence is clear: urgent and sustained mitigation across all sectors is the single most important health adaptation intervention,” states the executive summary. “There are profound physical, financial, and technological limits to adaptation, and health systems cannot remain resilient in a world of unchecked warming.” By reducing emissions, health systems would face less extreme weather events, fewer heat deaths, and smaller disease burdens, making adaptation needs less severe in the first place. That finding sits awkwardly with the Belém Health Action Plan itself, which contains no references to phasing out fossil fuels, the main driver of climate change. The fossil fuel omission came at the explicit instruction of the Brazilian COP30 presidency, according to people familiar with the negotiations, likely to open the door for more nations to sign on who will not commit to language on fossil fuel phase-out. What the report identifies as “the most effective measure” to protect health systems is excluded from the political Belém framework, which requires endorsement from governments, instead relegated to a supporting document with no political weight. “When COP30 delegates leave Belém, success will be measured by the courage governments have demonstrated to act on what is already known: that fossil fuels are destroying people’s health,” said Jeni Miller, health lead at the Global Climate and Health Alliance. “To ignore these realities would be to betray both science and humanity.” A $20 billion gap Adaptation needs for health systems estimated in the COP30 special report. Direct health sector adaptation interventions will require more than $22 billion annually by 2035, according to the report, approximately 7% of total adaptation financing needs in climate-vulnerable countries. Current health-specific climate finance reaching those countries totals around $500 to $700 million annually, representing 2% of adaptation funding and 0.5% of multilateral climate finance. Climate and health finance has grown considerably in recent years, rising tenfold from less than $1 billion in 2018 to $7.1 billion in commitments between 2018 and 2022, according to analysis published earlier this year by the Rockefeller Foundation, WHO and other partners. In 2022, this included $4.8 billion from bilateral donors, $600 million from multilateral development banks, $1.5 billion from multilateral health funds, and $130 million from philanthropies. The share of climate finance targeting the health sector increased from 1% in 2018 to 9% in 2022, the only sector apart from education to see an increase. Yet these flows remain far below estimated needs, and more than 90% of health adaptation funding from development banks arrives as loans rather than grants. “The evidence is clear that we have been too slow to act on climate change and we are now ill-equipped to cope with rising temperatures across the world,” said Alan Dangour, health and climate lead at the Wellcome Trust. The report identifies persistent gaps in readiness. Only 54% of national health adaptation plans assess risks to health facilities. Fewer than 30% of health adaptation studies consider income, 20% consider gender, and less than 1% include people with disabilities. More than 60% of National Adaptation Plans have no formal tracking or evaluation in place. “Extreme heat, air pollution and infectious disease all hit the most vulnerable hardest: children, pregnant people, older adults, outdoor workers, and communities with the fewest resources,” Dangour said. “At COP30 and beyond, governments must act on the science – cut emissions, invest in adaptation, and put health at the heart of climate action. Lives, economies, and our future depend on the solutions we deliver now.” Image Credits: COP30, COP30. How Intimate Partner Violence Affects Children 14/11/2025 Disha Shetty Children’s health suffers in households where their mothers are abused. Noma Bolani has a clear memory of her abusive father stopping the car in the middle of the highway in Durban, South Africa and asking her mother to get out. She was just six years old, but Bolani followed her mother out of the car, and together they sought help from a passing motorist. Bolani is now 38, and has anxiety stemming from early childhood experiences related to growing up with an abusive father and witnessing her mother being at the receiving end of emotional and financial violence. Ayesha*, 34, from New Delhi, India, grew up watching her mother being subjected to physical, emotional and financial violence from her father. He would sometimes also resort to silent treatment that would last weeks, refuse to pay school fees for Ayesha and her sister and resort to physical violence using belts, shoes and, at times, utensils. Ayesha suffers from Polycystic Ovary Disease (PCOD) that affects the regularity of her periods and causes hormonal changes. Her doctor believes the stress she was subjected to as a child played a significant role in worsening her PCOD. Like Bolani, Ayesha also carries mental health scars from watching violence directed at her mother. When mothers are at the receiving end of violence, it can make their children physically ill, according to a growing body of research. Impact on children’s health Health data from 37 countries in sub-Saharan Africa found that children under the age of five whose mothers experienced intimate partner violence (IPV) were more likely to develop diarrhoeal disease and symptoms of acute respiratory infections, according to a study published in The Lancet last year. It called for tailored interventions to address childhood morbidity and mortality attributed to IPV in “priority countries” – Burkina Faso, Burundi, Chad, Comoros, Gabon, Liberia, Nigeria, Sierra Leone, South Africa, and Uganda. “The most important thing is actually the cumulative effect,” said Abel Dadi, lead author and a social epidemiologist at the Menzies School of Health Research at the Charles Darwin University in Australia. His study looked at exposure to three kinds of violence – physical, sexual and emotional. “When they come together, their effect increases,” he said. Dadi’s team also found a strong link between IPV and stunting in Burundi, and IPV and children being underweight in Burkina Faso, although the results were not consistent across all countries. What is not yet clear is the exact pathway of how IPV directed towards the mother affects a child’s physical health. A mother and newborn at a health center in the Patna district of Bihar, India. Babies’ health and well-being is deeply affected by their mother’s health. Pervasive violence The World Health Organization (WHO) recognizes that violence against women is a major public health issue. Globally, one third (27%) of women experience IPV in their lifetime, according to WHO figures. In sub-Saharan Africa, these rates are even higher, with 45·6% of women experiencing IPV in their lifetime. Young women aged 15 to 19 are the most affected by IPV. By the time they are 19 years old, almost a quarter of adolescent girls (24%) who have been in a relationship have already been physically, sexually, or psychologically abused by a partner, according to WHO data. However, while it is widely accepted that intimate partner violence affects a woman’s mental, physical and sexual health at risk, its impact on children has not received the same attention. But a child’s health and well-being are completely dependent on their mother during pregnancy, and heavily dependent in the early years, so a mother’s health and well-being directly affects her child’s health. The WHO, which developed a toolkit with UN Women to prevent violence against women in 2019, acknowledges that violence against women and against children often occurs in the same household. Psychiatrists like Bessel van der Kolk, who wrote ‘The Body Keeps the Score’, and Gabor Mate, author of ‘The Myth of Normal’, have also brought the lifelong impact of childhood trauma into the public domain, particularly of growing up with abusive parents. But IPV has long been seen as a criminal issue rather than a health issue. In India, for example, hospitals have only recently started to offer health workers training to see it as a public health problem. “I don’t think it is a well-understood field of work in terms of a response from the courts or from the state’s response to children’s rights,” said Julie Thekkudan, South Asia consultant at Equality Now, a global non-profit that advocates for women’s and girls’ rights. Each dot represents a different country in the region. There has been progress, with signs that IPV is reducing in some low- and middle-income countries due to progress in women’s empowerment. The reason women find it hard to leave abusive relationships, especially in the Global South, is that they have been socialized to tolerate violence, according to Thekkudan. In societies that favour sons and devalue daughters, girls are socialized into believing that their “purpose in life is to get married”, she explained. Staying in a marriage, even if it is abusive, and seen as part of “making sure that your family honor is maintained”, Thekkudan added. That, in addition to the fact that women don’t always have the financial ability to leave, makes it a harder choice. Dadi said that any intervention design on maternal health should consider intimate partner violence as well as the mental health of the mother. Currently, most of these kinds of interventions are concentrated in high-income countries, according to research. On average, countries that do better on gender equity indexes usually also experienc lower levels of violence against women, according to takeaways published in The Lancet. But a woman’s higher economic status can also make her vulnerable. One study from sub-Saharan Africa showed that women’s employment, especially if they were the sole earners or if they earned more than their male partner, was linked to a higher level of intimate partner violence. Any solution “has to be a multi-pronged, multi-level”, said Thekkudan. “I don’t think there is one solution that will change the entire system or the structure.” *Name changed to protect identity Image Credits: Photo by Alex Pasarelu on Unsplash, BMGF, World Bank. Brazil Wins Limited Backing for COP30 Climate-Health Plan, But Nations Commit No Finance 13/11/2025 Stefan Anderson Belém framework wins backing from two dozen nations, but health remains outside formal UN climate negotiations. Brazil launched a sweeping climate-health action plan on Thursday, named after the COP30 host city in the Amazon, winning initial endorsements from roughly two dozen countries for a voluntary framework calling on nations to strengthen disease surveillance, build climate-resilient infrastructure, and protect vulnerable populations from the health impacts of rising temperatures and extreme weather. The Belém Health Action Plan outlines 60 action items across surveillance systems, evidence-based policies, and health innovation to address the health risks facing 3.3 billion people globally affected by the climate crisis. “The climate crisis is one of the most significant health challenges of our time,” states the plan, developed by Brazil’s health ministry in consultation with the WHO. Countries that endorse the voluntary framework will report their progress through UN climate negotiations during the second Global Stocktake at COP33 in 2028. The World Health Organization calls climate change “the greatest single risk to humanity,” and the World Bank estimates it could cause up to 15.6 million deaths between 2026 and 2050, with health impacts costing $8.6 to $15.4 trillion by mid-century. Initial supporters include European Union states such as France and Spain, small island nations like Tuvalu, African countries from Congo to Zambia, and others including Canada, Japan, the United Kingdom and Malaysia. Brazil’s health minister Alexandre Padilha said the plan had received backing from more than 80 nations and institutions, though the vast majority comprises civil society organisations like the Global Climate and Health Alliance, global health actors including Medicines for Malaria Venture and Drugs for Neglected Diseases Initiative, and UN agencies such as UNFPA, UNICEF and UNITAID. “We expect to have more by the end of the day and the end of the COP,” Padilha said, adding the presidency would continue “trying to engage and mobilise” more countries. “There’s a very strong commitment from our government and ministers of health in this plan.” Delegates gather in the plenary hall of COP30 in Belem for the launch of the Brazil-WHO-led health-climate adaptation plan. The voluntary nature of the framework and broad support for the Alliance for Transformative Action on Climate and Health (ATACH) — a WHO-led initiative launched at COP26, which now counts 101 members — suggest endorsements will likely grow, but implementation remains uncertain. WHO will serve as the secretariat for the Belém plan, measuring outcomes through the ATACH framework. The sole explicit dissent Thursday came from Egypt, part of the Baku coalition of previous COP presidencies that helped draft the plan. Egypt’s health minister expressed willingness to join but voiced “concern about the reference to the inclusion of LGBTIQ+ individuals, as such patterns fall outside the nationally recognised policy frameworks in the cultural context of Egypt.” Other coalition members, the United Arab Emirates and Azerbaijan, expressed political will to continue discussions but stopped short of endorsement, instead noting they had “contributed” and “noted with interest” the framework’s goals. “We have to look at the impact of climate change, one of the main threats to public health in the world today,” Padilha said. “Scientific evidence has shown clearly that the climate crisis is first and foremost a crisis of public health throughout the world.” “The time of warnings has finished. Now we are living in a time of consequences,” he added. “The climate has already changed, so we have no alternative but to have public policies to adapt and face climate change.” No money from nations The voluntary adaptation framework was endorsed by around countries but faces billions in funding shortfalls. The launch came with no new financial commitments from endorsing nations. The sole funding announcement came from a coalition of philanthropies including the Gates Foundation, Wellcome Trust, and Rockefeller Foundation: a $300m one-time grant to support climate-health adaptation measures. That figure is dwarfed by estimates that low- and middle-income countries require at least $11 billion annually just for basic health adaptation covering only disease control for malaria, dengue, diarrheal diseases, heat-related mortality, and essential surveillance improvements, according to the UN Environment Programme. “Health systems, already stretched and underfunded, are struggling to cope with these growing pressures, and most are still unprepared for what is coming,” said Marina Romanello, executive director of the Lancet Countdown at University College London. “Existing finance falls short by billions. Without urgent investment, we will not be able to protect populations from escalating climate impacts.” The $11 billion annual UNEP pricetag excludes respiratory illnesses, malnutrition, mental health services, additional infectious disease programs, workers’ health protection, supply chain adaptation, and health system decarbonisation — most of what the Belém plan contains. The UNFCCC estimates global health adaptation will require $26.8 to 29.4 billion annually by 2050. Current health-specific climate finance reaching those countries totals perhaps $500 to $700 million annually, representing 2% of adaptation funding and 0.5% of multilateral climate finance. “With regards to finance, that reality is that we have a deficit that is quite colossal,” said Carlos Lopes, Special Envoy for Africa to the COP30 Presidency. A WHO survey of National Health Adaptation Plans found all included climate-health risks. But just 28 nations worldwide have completed such plans. As temperatures continue rising and extreme weather events intensify, pressure mounts for health system adaptation at a moment when global health financing faces unprecedented strain. Overall development assistance for health dropped 21% from nearly $50 billion in 2024 to $39 billion in 2025, driven largely by US withdrawal from global health programs. The WHO itself faces budget shortfalls of 15-20%. Climate-health financing has grown from less than $1 billion globally in 2018 to $7.1 billion in 2022, the only aid sector to grow in that time apart from education, according to Rockefeller Foundation analysis. But substantial portions arrive as loans: 24% of bilateral climate-health funding and more than 90% from the Asian Development Bank and Inter-American Development Bank. Many developing countries now spend more on servicing debt than on healthcare, with low-income countries spending roughly 300 times less per capita on health than wealthy nations. That finance shortfall impacts their ability to implement adaptation plans like the Belem Framework: A 2021 WHO survey found that while half of the countries reported having national health-climate strategies, less than a quarter achieved high implementation levels. Insufficient financing was identified as the key barrier by 70% of responding countries. Health’s struggles mirror wider climate adaptation finance gaps. At COP26 in 2021, developed countries pledged to triple overall adaptation finance from 2019 levels to at least $120 billion per year by 2025. Actual flows across all sectors totalled $26 billion in 2023. Money will determine whether Belém becomes an implemented plan or another symbolic declaration. Without tens of billions in annual funding, it will likely follow previous COP health commitments that failed to translate rhetoric into action. “The Belém Health Action Plan gives us the blueprint,” said Simon Stiell, executive secretary of the UN Framework Convention on Climate Change. “What we need now is sustained, coordinated and well-financed action to turn its promises into protection for all.” What’s the plan? Launch event for the Belem Health Action Plan at COP30. The Belém plan functions as a framework of best practice recommendations for adapting health systems to the climate crisis, containing no legally binding requirements or targets. Instead, the document outlines recommendations organized around surveillance systems, policy interventions, and infrastructure overhauls that officials say are essential to protecting billions from climate-driven health crises. The one specific requirement: Countries that endorse it will report progress through the Paris Agreement’s Global Stocktake by COP33 in 2028, with no enforcement mechanisms or compliance requirements. “For decades, WHO has been calling for action to adapt health systems and build resilience to climate change,” said Tedros Adhanom Ghebreyesus, WHO director-general. “The Belém health action plan is how we can do that.” “Health systems themselves are affected by climate change, compromising their ability to deliver life-saving care when people need it most,” he said. “There can be no healthy people on a sick planet.” The first focus: building the capacity to see threats coming. The framework calls for climate-informed health monitoring that links meteorological agencies with health institutions, using predictive modelling to trigger early warnings before heat waves, floods, or disease outbreaks overwhelm communities. Surveillance should also track which populations face the greatest risks, data officials say is often missing. The second area addresses policy interventions to protect communities, including clean energy and sustainable transport, heat protection for workers, mental health support woven into climate response, and targeted measures for Indigenous peoples and persons with disabilities. ”For many countries, adaptation is a question of survival in the short run. If you don’t adapt, it threatens the coverage of health services of patients and professionals who are already facing adverse conditions,” Padhila said. “If we don’t adapt, we are going to increase inequality. In short, if you don’t adapt, we will kill people.” Water & power “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. Finance will determine whether the Belém framework’s most ambitious element, climate-resilient infrastructure, can be delivered. The plan envisions health facilities built to withstand climate shocks, renewable energy powering clinics, telehealth platforms extending care, and strategic stockpiles of temperature-stable medicines and vaccines. It calls for “integrated methodologies linking environmental, meteorological, social, climate and health monitoring data” with real-time surveillance and digital technologies as “structural components.” The problem: roughly 100,000 health facilities in sub-Saharan Africa lack reliable electricity, affecting nearly a billion people worldwide. Up to 70% of medical equipment in developing countries sits unused due to power failures. Cold chains for vaccines, digital surveillance systems, early warning platforms, and telehealth services all depend on reliable power that serving populations don’t have. Closing the healthcare electrification gap by 2030 would cost $4.9 billion, about $5 per person affected over six years. That’s less than one year of current global climate-health spending. “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. “It is very important we have the policies… working on the value chains of electricity to make sure that our babies, who are getting born without electricity,” have access to care. Water and sanitation infrastructure are equally critical, she noted. “If we bring water, we bring sanitation. There is already a disease that we will put away. We can tell our boys and girls to wash their hands, but how could they do it if there is no water at the school?” Just three nations have completed all four ATACH assessments as of 2025. The Belém plan’s success will depend not just on building infrastructure, but on countries’ ability to track and report progress. WHO will measure implementation through ATACH, its Alliance for Transformative Action on Climate and Health, which already requires members to complete vulnerability studies, adaptation plans, emissions inventories, and decarbonization roadmaps. The record so far suggests those demands exceed many countries’ capacity. Four years after ATACH’s launch in 2021, only three countries—France, Japan, and the UK—have completed all four assessments. Across 88 countries with available data, roughly 35-40% completed vulnerability assessments and 30% finished adaptation plans. In Africa, fewer than 10 of 29 ATACH members have completed vulnerability assessments. The Belém plan now adds reporting requirements on top of those existing gaps: tracking mental health impacts, monitoring workers’ heat exposure, establishing community resilience programmes, and climate-proofing supply chains, all by 2028. That creates an impossible bind. France, Japan, and the UK have the technical capacity and resources to meet these demands. Many other countries lack not only the expertise for complex reporting systems, but the basic infrastructure, electricity and water, that the plan assumes as a foundation. “Finance is still the bottleneck for us,” Princess Djigma said. Fossil fuel phase-out excluded Delegates arrive for the opening day of COP30 on the edge of the Brazilian Amazon. Notably absent from the plan is any reference to phasing out fossil fuels, the main driver of climate change and the resulting heat, extreme weather and air pollution killing approximately 8m people annually from respiratory and cardiovascular diseases. The omission came at the explicit instruction of the Brazilian COP30 presidency, according to people familiar with the negotiations. The exclusion comes as the International Energy Agency warned Wednesday that global oil and gas demand will rise for the next 25 years if countries do not change course. Until this year, all of the Paris-based body’s modelling assumed fossil fuel consumption would peak this decade. “Climate change is declining — and declining rapidly — in the international energy policy agenda,” said Fatih Birol, the IEA’s executive director. “And this is happening while 2024 was the hottest year in history.” Fifteen countries allocated more resources to fossil fuel net subsidies than their entire national health budgets. Birol’s findings align with the Lancet Countdown report published ahead of the summit, which found the 100 largest oil and gas companies have production strategies that put them on track to exceed their share of production consistent with 1.5 °C of heating by 189% in 2040, up from 183% in March 2024. Private bank lending to fossil fuel activities surged 29% to $611 billion in 2024, exceeding green sector lending by 15%. Some 73 of 87 countries reviewed provided net explicit fossil fuel subsidies in 2023, allocating nearly $1 trillion in direct support. Including indirect subsidies, that figure rises to over $7tn, according to the International Monetary Fund — more than governments spend annually on education and about two-thirds of what they spend on healthcare. The declining political attention extends to international engagement: Mentions of health and climate change by governments in their annual UN General Assembly statements declined from 62% in 2021 to 30% in 2024, according to the Lancet Countdown. “Record deaths from climate-driven wildfires in 2023 show that there’s no adaptation without mitigation,” said Nina Renshaw, head of health at the Clean Air Fund. “Ministries of Health and Finance won’t be able to bail hospitals and clinics out of the climate emergency if governments don’t stop the emissions which are already causing unprecedented harm.” ‘More than dialogue’ Delegates convened for the first-ever Health Day at a UN climate summit in Dubai. The Belém plan follows a pattern established at recent climate summits: the COP28 Dubai Health Declaration signed by 143 countries, the Baku Coalition for Climate and Health launched last year, and efforts stretching back to Glasgow in 2021. Like those efforts, Belém is a non-binding, voluntary process taking place outside formal UN negotiations. Criticisms of the outcomes of Dubai and Baku describe their outcomes as symbolic gestures that generate attention but fail to secure funding, sustained commitment, or implementation. Officials on Thursday repeatedly stressed the need to break the holding pattern. “This gathering must be more than dialogue,” said Jarbas Barbosa, director of the Pan American Health Organization. “It must galvanise collective action and inspire new policies dedicated to protecting everyone’s health from the worsening effects of climate change.” “The climatic crisis is fundamentally a health crisis,” Barbosa said. “We are not talking any more about distant or possible threats. Climate change is a present and growing reality.” Whether the Belém framework can overcome the obstacles that have stymied previous declarations — insufficient financing, limited technical capacity, competing priorities — remains uncertain. But Padilha argued the world has no choice but to try. “We are faced with a dilemma: we either continue to speak and speak and talk, or we can walk the walk and make the political commitment to do so,” he said. “We cannot accept the erosion of multilateralism in global health. Those who deny multilateralism are surrounding us. We will not listen to them.” Image Credits: COP30, COP30, COP30, COP30, COP30, COP30, WHO . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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How Intimate Partner Violence Affects Children 14/11/2025 Disha Shetty Children’s health suffers in households where their mothers are abused. Noma Bolani has a clear memory of her abusive father stopping the car in the middle of the highway in Durban, South Africa and asking her mother to get out. She was just six years old, but Bolani followed her mother out of the car, and together they sought help from a passing motorist. Bolani is now 38, and has anxiety stemming from early childhood experiences related to growing up with an abusive father and witnessing her mother being at the receiving end of emotional and financial violence. Ayesha*, 34, from New Delhi, India, grew up watching her mother being subjected to physical, emotional and financial violence from her father. He would sometimes also resort to silent treatment that would last weeks, refuse to pay school fees for Ayesha and her sister and resort to physical violence using belts, shoes and, at times, utensils. Ayesha suffers from Polycystic Ovary Disease (PCOD) that affects the regularity of her periods and causes hormonal changes. Her doctor believes the stress she was subjected to as a child played a significant role in worsening her PCOD. Like Bolani, Ayesha also carries mental health scars from watching violence directed at her mother. When mothers are at the receiving end of violence, it can make their children physically ill, according to a growing body of research. Impact on children’s health Health data from 37 countries in sub-Saharan Africa found that children under the age of five whose mothers experienced intimate partner violence (IPV) were more likely to develop diarrhoeal disease and symptoms of acute respiratory infections, according to a study published in The Lancet last year. It called for tailored interventions to address childhood morbidity and mortality attributed to IPV in “priority countries” – Burkina Faso, Burundi, Chad, Comoros, Gabon, Liberia, Nigeria, Sierra Leone, South Africa, and Uganda. “The most important thing is actually the cumulative effect,” said Abel Dadi, lead author and a social epidemiologist at the Menzies School of Health Research at the Charles Darwin University in Australia. His study looked at exposure to three kinds of violence – physical, sexual and emotional. “When they come together, their effect increases,” he said. Dadi’s team also found a strong link between IPV and stunting in Burundi, and IPV and children being underweight in Burkina Faso, although the results were not consistent across all countries. What is not yet clear is the exact pathway of how IPV directed towards the mother affects a child’s physical health. A mother and newborn at a health center in the Patna district of Bihar, India. Babies’ health and well-being is deeply affected by their mother’s health. Pervasive violence The World Health Organization (WHO) recognizes that violence against women is a major public health issue. Globally, one third (27%) of women experience IPV in their lifetime, according to WHO figures. In sub-Saharan Africa, these rates are even higher, with 45·6% of women experiencing IPV in their lifetime. Young women aged 15 to 19 are the most affected by IPV. By the time they are 19 years old, almost a quarter of adolescent girls (24%) who have been in a relationship have already been physically, sexually, or psychologically abused by a partner, according to WHO data. However, while it is widely accepted that intimate partner violence affects a woman’s mental, physical and sexual health at risk, its impact on children has not received the same attention. But a child’s health and well-being are completely dependent on their mother during pregnancy, and heavily dependent in the early years, so a mother’s health and well-being directly affects her child’s health. The WHO, which developed a toolkit with UN Women to prevent violence against women in 2019, acknowledges that violence against women and against children often occurs in the same household. Psychiatrists like Bessel van der Kolk, who wrote ‘The Body Keeps the Score’, and Gabor Mate, author of ‘The Myth of Normal’, have also brought the lifelong impact of childhood trauma into the public domain, particularly of growing up with abusive parents. But IPV has long been seen as a criminal issue rather than a health issue. In India, for example, hospitals have only recently started to offer health workers training to see it as a public health problem. “I don’t think it is a well-understood field of work in terms of a response from the courts or from the state’s response to children’s rights,” said Julie Thekkudan, South Asia consultant at Equality Now, a global non-profit that advocates for women’s and girls’ rights. Each dot represents a different country in the region. There has been progress, with signs that IPV is reducing in some low- and middle-income countries due to progress in women’s empowerment. The reason women find it hard to leave abusive relationships, especially in the Global South, is that they have been socialized to tolerate violence, according to Thekkudan. In societies that favour sons and devalue daughters, girls are socialized into believing that their “purpose in life is to get married”, she explained. Staying in a marriage, even if it is abusive, and seen as part of “making sure that your family honor is maintained”, Thekkudan added. That, in addition to the fact that women don’t always have the financial ability to leave, makes it a harder choice. Dadi said that any intervention design on maternal health should consider intimate partner violence as well as the mental health of the mother. Currently, most of these kinds of interventions are concentrated in high-income countries, according to research. On average, countries that do better on gender equity indexes usually also experienc lower levels of violence against women, according to takeaways published in The Lancet. But a woman’s higher economic status can also make her vulnerable. One study from sub-Saharan Africa showed that women’s employment, especially if they were the sole earners or if they earned more than their male partner, was linked to a higher level of intimate partner violence. Any solution “has to be a multi-pronged, multi-level”, said Thekkudan. “I don’t think there is one solution that will change the entire system or the structure.” *Name changed to protect identity Image Credits: Photo by Alex Pasarelu on Unsplash, BMGF, World Bank. Brazil Wins Limited Backing for COP30 Climate-Health Plan, But Nations Commit No Finance 13/11/2025 Stefan Anderson Belém framework wins backing from two dozen nations, but health remains outside formal UN climate negotiations. Brazil launched a sweeping climate-health action plan on Thursday, named after the COP30 host city in the Amazon, winning initial endorsements from roughly two dozen countries for a voluntary framework calling on nations to strengthen disease surveillance, build climate-resilient infrastructure, and protect vulnerable populations from the health impacts of rising temperatures and extreme weather. The Belém Health Action Plan outlines 60 action items across surveillance systems, evidence-based policies, and health innovation to address the health risks facing 3.3 billion people globally affected by the climate crisis. “The climate crisis is one of the most significant health challenges of our time,” states the plan, developed by Brazil’s health ministry in consultation with the WHO. Countries that endorse the voluntary framework will report their progress through UN climate negotiations during the second Global Stocktake at COP33 in 2028. The World Health Organization calls climate change “the greatest single risk to humanity,” and the World Bank estimates it could cause up to 15.6 million deaths between 2026 and 2050, with health impacts costing $8.6 to $15.4 trillion by mid-century. Initial supporters include European Union states such as France and Spain, small island nations like Tuvalu, African countries from Congo to Zambia, and others including Canada, Japan, the United Kingdom and Malaysia. Brazil’s health minister Alexandre Padilha said the plan had received backing from more than 80 nations and institutions, though the vast majority comprises civil society organisations like the Global Climate and Health Alliance, global health actors including Medicines for Malaria Venture and Drugs for Neglected Diseases Initiative, and UN agencies such as UNFPA, UNICEF and UNITAID. “We expect to have more by the end of the day and the end of the COP,” Padilha said, adding the presidency would continue “trying to engage and mobilise” more countries. “There’s a very strong commitment from our government and ministers of health in this plan.” Delegates gather in the plenary hall of COP30 in Belem for the launch of the Brazil-WHO-led health-climate adaptation plan. The voluntary nature of the framework and broad support for the Alliance for Transformative Action on Climate and Health (ATACH) — a WHO-led initiative launched at COP26, which now counts 101 members — suggest endorsements will likely grow, but implementation remains uncertain. WHO will serve as the secretariat for the Belém plan, measuring outcomes through the ATACH framework. The sole explicit dissent Thursday came from Egypt, part of the Baku coalition of previous COP presidencies that helped draft the plan. Egypt’s health minister expressed willingness to join but voiced “concern about the reference to the inclusion of LGBTIQ+ individuals, as such patterns fall outside the nationally recognised policy frameworks in the cultural context of Egypt.” Other coalition members, the United Arab Emirates and Azerbaijan, expressed political will to continue discussions but stopped short of endorsement, instead noting they had “contributed” and “noted with interest” the framework’s goals. “We have to look at the impact of climate change, one of the main threats to public health in the world today,” Padilha said. “Scientific evidence has shown clearly that the climate crisis is first and foremost a crisis of public health throughout the world.” “The time of warnings has finished. Now we are living in a time of consequences,” he added. “The climate has already changed, so we have no alternative but to have public policies to adapt and face climate change.” No money from nations The voluntary adaptation framework was endorsed by around countries but faces billions in funding shortfalls. The launch came with no new financial commitments from endorsing nations. The sole funding announcement came from a coalition of philanthropies including the Gates Foundation, Wellcome Trust, and Rockefeller Foundation: a $300m one-time grant to support climate-health adaptation measures. That figure is dwarfed by estimates that low- and middle-income countries require at least $11 billion annually just for basic health adaptation covering only disease control for malaria, dengue, diarrheal diseases, heat-related mortality, and essential surveillance improvements, according to the UN Environment Programme. “Health systems, already stretched and underfunded, are struggling to cope with these growing pressures, and most are still unprepared for what is coming,” said Marina Romanello, executive director of the Lancet Countdown at University College London. “Existing finance falls short by billions. Without urgent investment, we will not be able to protect populations from escalating climate impacts.” The $11 billion annual UNEP pricetag excludes respiratory illnesses, malnutrition, mental health services, additional infectious disease programs, workers’ health protection, supply chain adaptation, and health system decarbonisation — most of what the Belém plan contains. The UNFCCC estimates global health adaptation will require $26.8 to 29.4 billion annually by 2050. Current health-specific climate finance reaching those countries totals perhaps $500 to $700 million annually, representing 2% of adaptation funding and 0.5% of multilateral climate finance. “With regards to finance, that reality is that we have a deficit that is quite colossal,” said Carlos Lopes, Special Envoy for Africa to the COP30 Presidency. A WHO survey of National Health Adaptation Plans found all included climate-health risks. But just 28 nations worldwide have completed such plans. As temperatures continue rising and extreme weather events intensify, pressure mounts for health system adaptation at a moment when global health financing faces unprecedented strain. Overall development assistance for health dropped 21% from nearly $50 billion in 2024 to $39 billion in 2025, driven largely by US withdrawal from global health programs. The WHO itself faces budget shortfalls of 15-20%. Climate-health financing has grown from less than $1 billion globally in 2018 to $7.1 billion in 2022, the only aid sector to grow in that time apart from education, according to Rockefeller Foundation analysis. But substantial portions arrive as loans: 24% of bilateral climate-health funding and more than 90% from the Asian Development Bank and Inter-American Development Bank. Many developing countries now spend more on servicing debt than on healthcare, with low-income countries spending roughly 300 times less per capita on health than wealthy nations. That finance shortfall impacts their ability to implement adaptation plans like the Belem Framework: A 2021 WHO survey found that while half of the countries reported having national health-climate strategies, less than a quarter achieved high implementation levels. Insufficient financing was identified as the key barrier by 70% of responding countries. Health’s struggles mirror wider climate adaptation finance gaps. At COP26 in 2021, developed countries pledged to triple overall adaptation finance from 2019 levels to at least $120 billion per year by 2025. Actual flows across all sectors totalled $26 billion in 2023. Money will determine whether Belém becomes an implemented plan or another symbolic declaration. Without tens of billions in annual funding, it will likely follow previous COP health commitments that failed to translate rhetoric into action. “The Belém Health Action Plan gives us the blueprint,” said Simon Stiell, executive secretary of the UN Framework Convention on Climate Change. “What we need now is sustained, coordinated and well-financed action to turn its promises into protection for all.” What’s the plan? Launch event for the Belem Health Action Plan at COP30. The Belém plan functions as a framework of best practice recommendations for adapting health systems to the climate crisis, containing no legally binding requirements or targets. Instead, the document outlines recommendations organized around surveillance systems, policy interventions, and infrastructure overhauls that officials say are essential to protecting billions from climate-driven health crises. The one specific requirement: Countries that endorse it will report progress through the Paris Agreement’s Global Stocktake by COP33 in 2028, with no enforcement mechanisms or compliance requirements. “For decades, WHO has been calling for action to adapt health systems and build resilience to climate change,” said Tedros Adhanom Ghebreyesus, WHO director-general. “The Belém health action plan is how we can do that.” “Health systems themselves are affected by climate change, compromising their ability to deliver life-saving care when people need it most,” he said. “There can be no healthy people on a sick planet.” The first focus: building the capacity to see threats coming. The framework calls for climate-informed health monitoring that links meteorological agencies with health institutions, using predictive modelling to trigger early warnings before heat waves, floods, or disease outbreaks overwhelm communities. Surveillance should also track which populations face the greatest risks, data officials say is often missing. The second area addresses policy interventions to protect communities, including clean energy and sustainable transport, heat protection for workers, mental health support woven into climate response, and targeted measures for Indigenous peoples and persons with disabilities. ”For many countries, adaptation is a question of survival in the short run. If you don’t adapt, it threatens the coverage of health services of patients and professionals who are already facing adverse conditions,” Padhila said. “If we don’t adapt, we are going to increase inequality. In short, if you don’t adapt, we will kill people.” Water & power “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. Finance will determine whether the Belém framework’s most ambitious element, climate-resilient infrastructure, can be delivered. The plan envisions health facilities built to withstand climate shocks, renewable energy powering clinics, telehealth platforms extending care, and strategic stockpiles of temperature-stable medicines and vaccines. It calls for “integrated methodologies linking environmental, meteorological, social, climate and health monitoring data” with real-time surveillance and digital technologies as “structural components.” The problem: roughly 100,000 health facilities in sub-Saharan Africa lack reliable electricity, affecting nearly a billion people worldwide. Up to 70% of medical equipment in developing countries sits unused due to power failures. Cold chains for vaccines, digital surveillance systems, early warning platforms, and telehealth services all depend on reliable power that serving populations don’t have. Closing the healthcare electrification gap by 2030 would cost $4.9 billion, about $5 per person affected over six years. That’s less than one year of current global climate-health spending. “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. “It is very important we have the policies… working on the value chains of electricity to make sure that our babies, who are getting born without electricity,” have access to care. Water and sanitation infrastructure are equally critical, she noted. “If we bring water, we bring sanitation. There is already a disease that we will put away. We can tell our boys and girls to wash their hands, but how could they do it if there is no water at the school?” Just three nations have completed all four ATACH assessments as of 2025. The Belém plan’s success will depend not just on building infrastructure, but on countries’ ability to track and report progress. WHO will measure implementation through ATACH, its Alliance for Transformative Action on Climate and Health, which already requires members to complete vulnerability studies, adaptation plans, emissions inventories, and decarbonization roadmaps. The record so far suggests those demands exceed many countries’ capacity. Four years after ATACH’s launch in 2021, only three countries—France, Japan, and the UK—have completed all four assessments. Across 88 countries with available data, roughly 35-40% completed vulnerability assessments and 30% finished adaptation plans. In Africa, fewer than 10 of 29 ATACH members have completed vulnerability assessments. The Belém plan now adds reporting requirements on top of those existing gaps: tracking mental health impacts, monitoring workers’ heat exposure, establishing community resilience programmes, and climate-proofing supply chains, all by 2028. That creates an impossible bind. France, Japan, and the UK have the technical capacity and resources to meet these demands. Many other countries lack not only the expertise for complex reporting systems, but the basic infrastructure, electricity and water, that the plan assumes as a foundation. “Finance is still the bottleneck for us,” Princess Djigma said. Fossil fuel phase-out excluded Delegates arrive for the opening day of COP30 on the edge of the Brazilian Amazon. Notably absent from the plan is any reference to phasing out fossil fuels, the main driver of climate change and the resulting heat, extreme weather and air pollution killing approximately 8m people annually from respiratory and cardiovascular diseases. The omission came at the explicit instruction of the Brazilian COP30 presidency, according to people familiar with the negotiations. The exclusion comes as the International Energy Agency warned Wednesday that global oil and gas demand will rise for the next 25 years if countries do not change course. Until this year, all of the Paris-based body’s modelling assumed fossil fuel consumption would peak this decade. “Climate change is declining — and declining rapidly — in the international energy policy agenda,” said Fatih Birol, the IEA’s executive director. “And this is happening while 2024 was the hottest year in history.” Fifteen countries allocated more resources to fossil fuel net subsidies than their entire national health budgets. Birol’s findings align with the Lancet Countdown report published ahead of the summit, which found the 100 largest oil and gas companies have production strategies that put them on track to exceed their share of production consistent with 1.5 °C of heating by 189% in 2040, up from 183% in March 2024. Private bank lending to fossil fuel activities surged 29% to $611 billion in 2024, exceeding green sector lending by 15%. Some 73 of 87 countries reviewed provided net explicit fossil fuel subsidies in 2023, allocating nearly $1 trillion in direct support. Including indirect subsidies, that figure rises to over $7tn, according to the International Monetary Fund — more than governments spend annually on education and about two-thirds of what they spend on healthcare. The declining political attention extends to international engagement: Mentions of health and climate change by governments in their annual UN General Assembly statements declined from 62% in 2021 to 30% in 2024, according to the Lancet Countdown. “Record deaths from climate-driven wildfires in 2023 show that there’s no adaptation without mitigation,” said Nina Renshaw, head of health at the Clean Air Fund. “Ministries of Health and Finance won’t be able to bail hospitals and clinics out of the climate emergency if governments don’t stop the emissions which are already causing unprecedented harm.” ‘More than dialogue’ Delegates convened for the first-ever Health Day at a UN climate summit in Dubai. The Belém plan follows a pattern established at recent climate summits: the COP28 Dubai Health Declaration signed by 143 countries, the Baku Coalition for Climate and Health launched last year, and efforts stretching back to Glasgow in 2021. Like those efforts, Belém is a non-binding, voluntary process taking place outside formal UN negotiations. Criticisms of the outcomes of Dubai and Baku describe their outcomes as symbolic gestures that generate attention but fail to secure funding, sustained commitment, or implementation. Officials on Thursday repeatedly stressed the need to break the holding pattern. “This gathering must be more than dialogue,” said Jarbas Barbosa, director of the Pan American Health Organization. “It must galvanise collective action and inspire new policies dedicated to protecting everyone’s health from the worsening effects of climate change.” “The climatic crisis is fundamentally a health crisis,” Barbosa said. “We are not talking any more about distant or possible threats. Climate change is a present and growing reality.” Whether the Belém framework can overcome the obstacles that have stymied previous declarations — insufficient financing, limited technical capacity, competing priorities — remains uncertain. But Padilha argued the world has no choice but to try. “We are faced with a dilemma: we either continue to speak and speak and talk, or we can walk the walk and make the political commitment to do so,” he said. “We cannot accept the erosion of multilateralism in global health. Those who deny multilateralism are surrounding us. We will not listen to them.” Image Credits: COP30, COP30, COP30, COP30, COP30, COP30, WHO . Posts navigation Older postsNewer posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. 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Brazil Wins Limited Backing for COP30 Climate-Health Plan, But Nations Commit No Finance 13/11/2025 Stefan Anderson Belém framework wins backing from two dozen nations, but health remains outside formal UN climate negotiations. Brazil launched a sweeping climate-health action plan on Thursday, named after the COP30 host city in the Amazon, winning initial endorsements from roughly two dozen countries for a voluntary framework calling on nations to strengthen disease surveillance, build climate-resilient infrastructure, and protect vulnerable populations from the health impacts of rising temperatures and extreme weather. The Belém Health Action Plan outlines 60 action items across surveillance systems, evidence-based policies, and health innovation to address the health risks facing 3.3 billion people globally affected by the climate crisis. “The climate crisis is one of the most significant health challenges of our time,” states the plan, developed by Brazil’s health ministry in consultation with the WHO. Countries that endorse the voluntary framework will report their progress through UN climate negotiations during the second Global Stocktake at COP33 in 2028. The World Health Organization calls climate change “the greatest single risk to humanity,” and the World Bank estimates it could cause up to 15.6 million deaths between 2026 and 2050, with health impacts costing $8.6 to $15.4 trillion by mid-century. Initial supporters include European Union states such as France and Spain, small island nations like Tuvalu, African countries from Congo to Zambia, and others including Canada, Japan, the United Kingdom and Malaysia. Brazil’s health minister Alexandre Padilha said the plan had received backing from more than 80 nations and institutions, though the vast majority comprises civil society organisations like the Global Climate and Health Alliance, global health actors including Medicines for Malaria Venture and Drugs for Neglected Diseases Initiative, and UN agencies such as UNFPA, UNICEF and UNITAID. “We expect to have more by the end of the day and the end of the COP,” Padilha said, adding the presidency would continue “trying to engage and mobilise” more countries. “There’s a very strong commitment from our government and ministers of health in this plan.” Delegates gather in the plenary hall of COP30 in Belem for the launch of the Brazil-WHO-led health-climate adaptation plan. The voluntary nature of the framework and broad support for the Alliance for Transformative Action on Climate and Health (ATACH) — a WHO-led initiative launched at COP26, which now counts 101 members — suggest endorsements will likely grow, but implementation remains uncertain. WHO will serve as the secretariat for the Belém plan, measuring outcomes through the ATACH framework. The sole explicit dissent Thursday came from Egypt, part of the Baku coalition of previous COP presidencies that helped draft the plan. Egypt’s health minister expressed willingness to join but voiced “concern about the reference to the inclusion of LGBTIQ+ individuals, as such patterns fall outside the nationally recognised policy frameworks in the cultural context of Egypt.” Other coalition members, the United Arab Emirates and Azerbaijan, expressed political will to continue discussions but stopped short of endorsement, instead noting they had “contributed” and “noted with interest” the framework’s goals. “We have to look at the impact of climate change, one of the main threats to public health in the world today,” Padilha said. “Scientific evidence has shown clearly that the climate crisis is first and foremost a crisis of public health throughout the world.” “The time of warnings has finished. Now we are living in a time of consequences,” he added. “The climate has already changed, so we have no alternative but to have public policies to adapt and face climate change.” No money from nations The voluntary adaptation framework was endorsed by around countries but faces billions in funding shortfalls. The launch came with no new financial commitments from endorsing nations. The sole funding announcement came from a coalition of philanthropies including the Gates Foundation, Wellcome Trust, and Rockefeller Foundation: a $300m one-time grant to support climate-health adaptation measures. That figure is dwarfed by estimates that low- and middle-income countries require at least $11 billion annually just for basic health adaptation covering only disease control for malaria, dengue, diarrheal diseases, heat-related mortality, and essential surveillance improvements, according to the UN Environment Programme. “Health systems, already stretched and underfunded, are struggling to cope with these growing pressures, and most are still unprepared for what is coming,” said Marina Romanello, executive director of the Lancet Countdown at University College London. “Existing finance falls short by billions. Without urgent investment, we will not be able to protect populations from escalating climate impacts.” The $11 billion annual UNEP pricetag excludes respiratory illnesses, malnutrition, mental health services, additional infectious disease programs, workers’ health protection, supply chain adaptation, and health system decarbonisation — most of what the Belém plan contains. The UNFCCC estimates global health adaptation will require $26.8 to 29.4 billion annually by 2050. Current health-specific climate finance reaching those countries totals perhaps $500 to $700 million annually, representing 2% of adaptation funding and 0.5% of multilateral climate finance. “With regards to finance, that reality is that we have a deficit that is quite colossal,” said Carlos Lopes, Special Envoy for Africa to the COP30 Presidency. A WHO survey of National Health Adaptation Plans found all included climate-health risks. But just 28 nations worldwide have completed such plans. As temperatures continue rising and extreme weather events intensify, pressure mounts for health system adaptation at a moment when global health financing faces unprecedented strain. Overall development assistance for health dropped 21% from nearly $50 billion in 2024 to $39 billion in 2025, driven largely by US withdrawal from global health programs. The WHO itself faces budget shortfalls of 15-20%. Climate-health financing has grown from less than $1 billion globally in 2018 to $7.1 billion in 2022, the only aid sector to grow in that time apart from education, according to Rockefeller Foundation analysis. But substantial portions arrive as loans: 24% of bilateral climate-health funding and more than 90% from the Asian Development Bank and Inter-American Development Bank. Many developing countries now spend more on servicing debt than on healthcare, with low-income countries spending roughly 300 times less per capita on health than wealthy nations. That finance shortfall impacts their ability to implement adaptation plans like the Belem Framework: A 2021 WHO survey found that while half of the countries reported having national health-climate strategies, less than a quarter achieved high implementation levels. Insufficient financing was identified as the key barrier by 70% of responding countries. Health’s struggles mirror wider climate adaptation finance gaps. At COP26 in 2021, developed countries pledged to triple overall adaptation finance from 2019 levels to at least $120 billion per year by 2025. Actual flows across all sectors totalled $26 billion in 2023. Money will determine whether Belém becomes an implemented plan or another symbolic declaration. Without tens of billions in annual funding, it will likely follow previous COP health commitments that failed to translate rhetoric into action. “The Belém Health Action Plan gives us the blueprint,” said Simon Stiell, executive secretary of the UN Framework Convention on Climate Change. “What we need now is sustained, coordinated and well-financed action to turn its promises into protection for all.” What’s the plan? Launch event for the Belem Health Action Plan at COP30. The Belém plan functions as a framework of best practice recommendations for adapting health systems to the climate crisis, containing no legally binding requirements or targets. Instead, the document outlines recommendations organized around surveillance systems, policy interventions, and infrastructure overhauls that officials say are essential to protecting billions from climate-driven health crises. The one specific requirement: Countries that endorse it will report progress through the Paris Agreement’s Global Stocktake by COP33 in 2028, with no enforcement mechanisms or compliance requirements. “For decades, WHO has been calling for action to adapt health systems and build resilience to climate change,” said Tedros Adhanom Ghebreyesus, WHO director-general. “The Belém health action plan is how we can do that.” “Health systems themselves are affected by climate change, compromising their ability to deliver life-saving care when people need it most,” he said. “There can be no healthy people on a sick planet.” The first focus: building the capacity to see threats coming. The framework calls for climate-informed health monitoring that links meteorological agencies with health institutions, using predictive modelling to trigger early warnings before heat waves, floods, or disease outbreaks overwhelm communities. Surveillance should also track which populations face the greatest risks, data officials say is often missing. The second area addresses policy interventions to protect communities, including clean energy and sustainable transport, heat protection for workers, mental health support woven into climate response, and targeted measures for Indigenous peoples and persons with disabilities. ”For many countries, adaptation is a question of survival in the short run. If you don’t adapt, it threatens the coverage of health services of patients and professionals who are already facing adverse conditions,” Padhila said. “If we don’t adapt, we are going to increase inequality. In short, if you don’t adapt, we will kill people.” Water & power “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. Finance will determine whether the Belém framework’s most ambitious element, climate-resilient infrastructure, can be delivered. The plan envisions health facilities built to withstand climate shocks, renewable energy powering clinics, telehealth platforms extending care, and strategic stockpiles of temperature-stable medicines and vaccines. It calls for “integrated methodologies linking environmental, meteorological, social, climate and health monitoring data” with real-time surveillance and digital technologies as “structural components.” The problem: roughly 100,000 health facilities in sub-Saharan Africa lack reliable electricity, affecting nearly a billion people worldwide. Up to 70% of medical equipment in developing countries sits unused due to power failures. Cold chains for vaccines, digital surveillance systems, early warning platforms, and telehealth services all depend on reliable power that serving populations don’t have. Closing the healthcare electrification gap by 2030 would cost $4.9 billion, about $5 per person affected over six years. That’s less than one year of current global climate-health spending. “It’s about the billions of people that we have the mandate here to make sure that we can change their lives, promoting health,” said Princess Abze Djigma of Burkina Faso. “It is very important we have the policies… working on the value chains of electricity to make sure that our babies, who are getting born without electricity,” have access to care. Water and sanitation infrastructure are equally critical, she noted. “If we bring water, we bring sanitation. There is already a disease that we will put away. We can tell our boys and girls to wash their hands, but how could they do it if there is no water at the school?” Just three nations have completed all four ATACH assessments as of 2025. The Belém plan’s success will depend not just on building infrastructure, but on countries’ ability to track and report progress. WHO will measure implementation through ATACH, its Alliance for Transformative Action on Climate and Health, which already requires members to complete vulnerability studies, adaptation plans, emissions inventories, and decarbonization roadmaps. The record so far suggests those demands exceed many countries’ capacity. Four years after ATACH’s launch in 2021, only three countries—France, Japan, and the UK—have completed all four assessments. Across 88 countries with available data, roughly 35-40% completed vulnerability assessments and 30% finished adaptation plans. In Africa, fewer than 10 of 29 ATACH members have completed vulnerability assessments. The Belém plan now adds reporting requirements on top of those existing gaps: tracking mental health impacts, monitoring workers’ heat exposure, establishing community resilience programmes, and climate-proofing supply chains, all by 2028. That creates an impossible bind. France, Japan, and the UK have the technical capacity and resources to meet these demands. Many other countries lack not only the expertise for complex reporting systems, but the basic infrastructure, electricity and water, that the plan assumes as a foundation. “Finance is still the bottleneck for us,” Princess Djigma said. Fossil fuel phase-out excluded Delegates arrive for the opening day of COP30 on the edge of the Brazilian Amazon. Notably absent from the plan is any reference to phasing out fossil fuels, the main driver of climate change and the resulting heat, extreme weather and air pollution killing approximately 8m people annually from respiratory and cardiovascular diseases. The omission came at the explicit instruction of the Brazilian COP30 presidency, according to people familiar with the negotiations. The exclusion comes as the International Energy Agency warned Wednesday that global oil and gas demand will rise for the next 25 years if countries do not change course. Until this year, all of the Paris-based body’s modelling assumed fossil fuel consumption would peak this decade. “Climate change is declining — and declining rapidly — in the international energy policy agenda,” said Fatih Birol, the IEA’s executive director. “And this is happening while 2024 was the hottest year in history.” Fifteen countries allocated more resources to fossil fuel net subsidies than their entire national health budgets. Birol’s findings align with the Lancet Countdown report published ahead of the summit, which found the 100 largest oil and gas companies have production strategies that put them on track to exceed their share of production consistent with 1.5 °C of heating by 189% in 2040, up from 183% in March 2024. Private bank lending to fossil fuel activities surged 29% to $611 billion in 2024, exceeding green sector lending by 15%. Some 73 of 87 countries reviewed provided net explicit fossil fuel subsidies in 2023, allocating nearly $1 trillion in direct support. Including indirect subsidies, that figure rises to over $7tn, according to the International Monetary Fund — more than governments spend annually on education and about two-thirds of what they spend on healthcare. The declining political attention extends to international engagement: Mentions of health and climate change by governments in their annual UN General Assembly statements declined from 62% in 2021 to 30% in 2024, according to the Lancet Countdown. “Record deaths from climate-driven wildfires in 2023 show that there’s no adaptation without mitigation,” said Nina Renshaw, head of health at the Clean Air Fund. “Ministries of Health and Finance won’t be able to bail hospitals and clinics out of the climate emergency if governments don’t stop the emissions which are already causing unprecedented harm.” ‘More than dialogue’ Delegates convened for the first-ever Health Day at a UN climate summit in Dubai. The Belém plan follows a pattern established at recent climate summits: the COP28 Dubai Health Declaration signed by 143 countries, the Baku Coalition for Climate and Health launched last year, and efforts stretching back to Glasgow in 2021. Like those efforts, Belém is a non-binding, voluntary process taking place outside formal UN negotiations. Criticisms of the outcomes of Dubai and Baku describe their outcomes as symbolic gestures that generate attention but fail to secure funding, sustained commitment, or implementation. Officials on Thursday repeatedly stressed the need to break the holding pattern. “This gathering must be more than dialogue,” said Jarbas Barbosa, director of the Pan American Health Organization. “It must galvanise collective action and inspire new policies dedicated to protecting everyone’s health from the worsening effects of climate change.” “The climatic crisis is fundamentally a health crisis,” Barbosa said. “We are not talking any more about distant or possible threats. Climate change is a present and growing reality.” Whether the Belém framework can overcome the obstacles that have stymied previous declarations — insufficient financing, limited technical capacity, competing priorities — remains uncertain. But Padilha argued the world has no choice but to try. “We are faced with a dilemma: we either continue to speak and speak and talk, or we can walk the walk and make the political commitment to do so,” he said. “We cannot accept the erosion of multilateralism in global health. Those who deny multilateralism are surrounding us. We will not listen to them.” Image Credits: COP30, COP30, COP30, COP30, COP30, COP30, WHO . Posts navigation Older postsNewer posts