Extreme weather events reached dangerous levels in 2024 due to record-breaking temperatures.

The year 2024 is set to be the warmest year on record, the United Nations’ (UN) weather agency, the World Meteorological Organization (WMO), said in an end-year statement on 30 December. This year caps a decade of unprecedented heat fuelled by human activities, the WMO said.

“In my first year as WMO Secretary-General, I have issued repeated Red Alerts about the state of the climate,” said WMO Secretary-General Celeste Saulo.

“This year we saw record-breaking rainfall and flooding events and terrible loss of life in so many countries, causing heartbreak to communities on every continent. Tropical cyclones caused a terrible human and economic toll, most recently in the French overseas department of Mayotte in the Indian Ocean. Intense heat scorched dozens of countries, with temperatures topping 50°C on a number of occasions. Wildfires wreaked devastation,” Saulo said.

Her comments foreshadowed the expected findings of WMO’s formal consolidated global temperatures report for 2024, due to be published in early January.

In a close-up look at just 26 of the 219 major weather events of 2024, climate change-related extremes contributed to the deaths of at least 3,700 people in floods, typhoons, hurricanes, heat waves and wildfires, while leading to the displacement of millions.

This, according to a separate report by World Weather Attribution (WWA), an international consortium of scientists.

“It’s likely the total number of people killed in extreme weather events intensified by climate change this year is in the tens, or hundreds of thousands,” the report stated.

Extreme heat more and more devastating

Climate change also was responsible for an additional 41 days of dangerous heat exposure, per person, on average, in 2024 as compared to pre-industrial exposure levels, the WWA scientists found.

World Weather Attribution studied 26 weather events closely out of the 219 events in 2024.

What is worse is that the countries that experienced the highest number of dangerous heat days are overwhelmingly small islands and developing states that tend to have limited resources to cope.

“Today I can officially report that we have just endured a decade of deadly heat. The top ten hottest years on record have happened in the last ten years, including 2024,” said UN Secretary-General António Guterres in his own New Year message.

“This is climate breakdown – in real time. We must exit this road to ruin – and we have no time to lose. In 2025, countries must put the world on a safer path by dramatically slashing emissions, and supporting the transition to a renewable future,” Guterres said.

Runaway emissions locking in even more heat

Trends are only getting worse, according to the WMO. Currently, the world is at 1.3°C of human-induced warming. In the next five years the annual global temperature is very likely to temporarily breach the 1.5°C target above pre-industrial era that was the target set as a part of the Paris agreement.

And with the most recent UN climate conference COP in Azerbaijan’s capital Baku this November failing to set any new targets for reining in record high fossil fuel burning and emissions, while delivering only $300 billion annually of the $1trillion in climate finance demanded by the poor countries to make a green energy transition, the chances of halting and reversing those trends any time soon looked grim at year’s end.

“Every fraction of a degree of warming matters, and increases climate extremes, impacts and risks,” WMO’s Saulo also said in her a chilling warning. “Temperatures are only part of the picture. Climate change plays out before our eyes on an almost daily basis in the form of increased occurrence and impact of extreme weather events,” she said.

Better monitoring of GHG concentrations 

WMO is in the process of rolling out the Global Greenhouse Gas Watch initiative that will track the GHG concentrations and monthly net fluxes in the atmosphere, for carbon dioxide (CO2), methane (CH4), and nitrous oxide (N2O) at a 1° × 1° geographic latitude-longitude grid resolution (about 100×100 km spatial resolution).

The aim is to “reduce uncertainties and improve the reliability of GHG monitoring,” the organization said, thus helping countries track the atmospheric impacts of greenhouse gas emissions, while addressing data gaps.

Climate change also added 41 days of dangerous heat in 2024, according to a report jointly produced by the team at World Weather Attribution (WWA) and Climate Central.

Push for early warning systems, more data

The UN also is pushing countries to ramp up their own early warning extreme weather systems. Under the Early Warnings for All initiative, WMO plans to support countries in developing their climate services and delivery programmes.

Other multilateral agencies are also doing the same. In Asia, the Asian Development Bank Institute is pushing countries in the Asia and Pacific region to collect more climate data that could  help prioritize vulnerable communities and respond effectively.

Image Credits: WMO, WWA, WMO.

They reached out for a dialogue at the height of the COVID pandemic: Michelle Williams, then dean of Harvard’s School of Public Health, and Margaret Chan, dean of China’s Vanke’s School – face to face in  Geneva in May 2024.

In April 2022, amidst the continuing uproar of the COVID pandemic, four deans of schools of public health from the USA, China, Switzerland and Singapore, first got on a call with each other to see how they could ramp up cooperation – remotely.

Barred by lockdowns from the usual academic meetings and conferences, the urge to link up was stronger than ever.

Co-founders of the high-powered group were Michelle Williams, then dean of Harvard’s School of Public Health, and former WHO Director General  Margaret Chan, now dean of Beijing’s brand-new Vanke School of Public Health.

“At the height of the pandemic, my good friend here, Margaret and several others amongst us, decided that we needed to come together with deans of schools of public health, to promote solidarity, and to continue to be assertive about what global health diplomacy means for all of us,” said Williams at the first face-to-face Coalition meeting in May 2024.

“We were surprised at the lack of dialogue, the lack of cooperation and collaboration worldwide,” said Chan, of that difficult pandemic period. So, she was delighted when Williams reached out about a conferring virtually. “We felt that change is necessary, and we can make a contribution as universities – which represent the creation and translation of knowledge, through science, to policymaking.”

Other founding members included Antoine Flahault, director of the Zurich-based Swiss School of Public Health and long-time actor in Geneva, the world’s “global health hub”. And the deans of public health schools at the University of Cape Town; Mahidol University, Thailand. Heads of public health institutes in Huazhong, China, Mexico, Sydney, Chile and Singapore.

Online hosted by China

Vanke School of Public Health, Tsinghua University, China.

 That first encounter, organized online by Chan at the Vanke School, was naturally focused on health issues related to the COVID crisis – but with an eye beyond the immediate issues of vaccines, travel restrictions and lockdowns to the long-term challenges that everyone knew lay ahead.

Challenges like the need for countries to come together on the all-important task of building more resilient health systems, better prepared for the next pandemic.

“Working with Dr. Margaret Chan to co-create the Coalition was one of the few bright spots during the early part of the pandemic,” Williams, who recently stepped down as dean, told Health Policy Watch by email from California, where she is currently on sabbatical.

“I was delighted that Margaret, and I joined forces and then had other deans join us. I felt it was important that we academic leaders needed to redouble our efforts to break down real and perceived barriers to global health collaboration, cooperation and diplomacy.

“All around us, in political and public health practice spaces, I observed decision makers looking inward and sometimes missing the important imperatives and values of global public health,” Williams said.

“Vaccine nationalism, unthoughtful border closings and some other policies ran counter to public health, global health diplomacy and practice.  This was disheartening especially as pandemic threats, threats from climate change and other threats like antimicrobial resistance are global threats that require global cooperation.”

Linking academia’s public health leadership

‘Our aim is not to duplicate’, Antoine Flahault, dean of the Swiss School of Public Health (on left), with Geneva University’s Alexandra Calmy at a meeting of the Coalition in May, 2024

Indeed, while there are other established coalitions of Public Health Schools, mostly US-based, such as the American Association of Schools of Public Health, the World Federation of Schools of Public Health, and the Consortium of Universities for Global Health, one unique aspect of the GHF-based Coalition of Deans has been the way it links public health leaders, and not only the institutions, says Flahault.

“Our aim is not to duplicate, but to be complementary to all of these groups, with which we coordinate,” he said.

The loosely-knit group now includes about a dozen institutions, as well as the leading European and American associations or federations of Public Health universities and schools.

“Our vision is that this Global Coalition will allow us to learn more from each other, sharing our experiences, facilitating exchanges of students and faculty among schools and fostering joint research programs,” Flahault observed.

Adds Michel Kazatchkine, a physician, academic and former French diplomat, who also spoke at the group’s last meeting on the margins of the World Health Assembly:

‘Increasing interest in health diplomacy’: Michel Kazatchkine, physician and former diplomat.

“We’re now seeing an increasing interest in health diplomacy. But in this context, academia is particularly important because science is essential in evaluating the impact of policies and providing feedback analysis to politicians so that they can correct trajectories if needed.

“And academia provides the freedom to do research on any topic, even the most sensitive – to collect, analyze and speak about the findings of your data. So, we should not underestimate the role of academia as a fundamental pillar of knowledge-based, democratic societies.”

Focusing on planetary health and other neglected topics

The Sydney School of Public Health’s Flagship planetary health initiative in Fiji was one example featured at the Geneva Health Forum. A study of watershed interventions, it aims to reduce incidence of typhoid, dengue and other deadly diseases in Pacific Island countries.

This year, after two years of remote meetings organized by the Vanke School and Harvard in succession, members of the coalition convened face-to-face, for the first time in Geneva, on the margins of the World Health Assembly, hosted by the Geneva Health Forum and the University of Geneva.

The group focused on planetary health as their principal topic.

“We shared experiences from Australia, China, and the USA about academic programmes dedicated to this issue – and asked the question: how do schools of public health integrate planetary health into their curriculum?” Flahault said. Doctoral and masters’ students from selected schools were also invited to speak along with faculty about lessons learned, he noted.

The discussions continued a thread from the 2023 remote meeting, which examined climate-driven food insecurity in the global health context – another cutting- edge issue that rarely gets much attention in classic public health school textbooks or classrooms.

“The Coalition of Deans have already been instrumental insofar as bringing attention to the importance of creating multi-national and interdisciplinary collaboration to bring multiple perspectives into designing curriculum,” reflected Williams.

“We’ve also provided a platform (as seen in the meeting hosted by Prof Flahault last spring) for showcasing junior faculty members and graduate students working in the fields of global planetary health and environmental justice,” Williams pointed out.

The effort is all the more topical insofar as Harvard’s Chan School of Public Health just launched a concentration in climate and planetary health in 2024.

In China, the Vanke School is also planning to pilot a planetary health course in 2025. That course will bring together students of public health with those in students from economics, urban design, environmental health sciences and engineering to examine multi-sectoral challenges and design solutions, said Chan, speaking with Health Policy Watch.

Chan: Vanke’s new planetary health course will bring together students of diverse disciplines.

“Everyone knows about how John Snow stopped the cholera epidemic [by breaking the pump on a contaminated water cistern], but what about the sanitary engineer who helps to renovate and overhaul the London sewage system,” Chan said.

Tsinghua University, where the Vanke School is located, is world famous for its engineering school, she observes.  “So. this will train future decision-makers to bridge between disciplines such as engineering and health.”

Indoor air pollution and wastewater epidemiology

Along with partners in the WHO, the GHF and European Universities, Coalition members have also supported the development of a series of events on other interdisciplinary health topics over the past year.

These included a conference on Indoor Air Pollution, in September 2023 in Berne, as well as a recent Conference in Paris on Wastewater-based Epidemiology. See related story:

Post Pandemic: Wastewater-based Surveillance of Diseases Comes of Age 

 

“Of course we have moved on from the pandemic to other topics,” noted Chan, speaking with Health Policy Watch recently in a phone interview. “The change in the conversation is a reflection of the changes in the current trends in Public Health. And it’s going to be more diverse as we move along.

One topic she’d like to see the Coalition tackle at some point would be the challenges of harnessing AI for good in the broad context of public health research and policymaking.

“There is a lot of talk about AI in clinical work, but what about AI in public health?” she asks. “Patient confidentiality is important. But we also need policies in place to enable the use of AI in research and outreach, but also to protect people’s privacy.”

Whatever the theme may be, the approach is the same, says Williams, who was instrumental in establishing a student exchange programme between Harvard and the Vanke School in 2021.

“Sharing of teaching materials and experiences related to launching new courses and concentrations are ways we can facilitate the spread of ideas across other universities.

“Developing and supporting annual workshops, and supporting student and faculty exchanges, are another. It is hoped that the Deans can secure resources to help operationalize these collaborative initiatives.”

Looking forward to 2025

Cabo Verde's Minister of Health, Filomena Mendes Gonçalves.
Geneva Health Forum 2024 session on malaria elimination with Cabo Verde’s Minister of Health, Filomena Mendes Gonçalves.

Looking forward, Flahault says the group aims to maintain its informal modus operandi, to facilitate exchange across borders – and keep the focus on meaningful meetings and liaisons.

“We are a lean organization without any budget and staff and not competing with any other organizations,” Flahault said.

At the same time, he envisions the Coalition playing an advisory role in a soon-to-be-formed Think Tank that aims to continue dialogue and problem-solving around the themes of the Geneva Health Forum throughout the year. “One major fruit or byproduct of this will be the GHF Think Tank, which we are launching this spring, and will tap the academic network the Global Coalition assembles,” he said.

That, in addition to their annual meetings, on the margins of the Geneva Health Forum’s annual conference during the World Health Assembly – with the next event organized by Teo Yik-Ying, dean of the Saw Swee Hock School of Public Health at the National University of Singapore.

Now that face-to-face meetings are once more feasible, working from the Geneva axis offers a unique vantage point that can transcend some of the sharp geopolitical divides that academic leaders face in dialogues at other venues, Flahault also points out.

Says Chan, who served as WHO Director General from 2006-2017, “I’m very biased – to me, Geneva is the capital of public health. And all countries come to the World Health Assembly. So, it’s natural that all of us in the Coalition would meet here, to make our voices heard.”

Returning to basics of infectious disease elimination

A child paralyzed by polio breathes in an iron lung – the best available intervention before the polio vaccine’s discovery in 1955.

Along with emerging global health issues around climate and planetary health – Flahault sees a future role for the group in reviving interest around some of the world’s longstanding, and unsolved public health challenges – such as elimination of polio, cholera and other preventable infectious diseases.

“Personally, I would love to see a WHA resolution against the three major diseases, polio malaria and cholera – with the same sense of determination we displaced against smallpox in the 1950s and 60s, with the same sharp formulation, we want to eradicate these diseases as soon as possible,” he said in a recent interview.

 “All of the major actors would push and row together to make this successful. For polio it’s already done but we have to say we have to end the job.

“We need to be modest and realistic,” Flahault admitted. “Surely, eradicating cholera from the planet, which has already been the subject of one WHA resolution, needs a huge political commitment. This is not in the portfolio of the Global Coalition or schools of public health.

“But we could still play a role. With players in the media ..we could try to mobilize political leadership which is lacking today. We don’t have many political leaders embracing global health issues, as happened during the pandemic, but today global health issues remain a source of power for promoting multilateral commitments.

“And in the coalition, we have a great opportunity for liaison between China, the USA and Europe and all of the other constituencies that are in the room, which give us an opportunity to push public health as a form of ‘soft power’ to move forward agendas.

After all, we succeeded in the 20th century to eliminate smallpox at the height of the cold war between the USSR and the USA.  It was not easy, but we succeeded thanks to a shared commitment to health.”

–Written as part of a Health Policy Watch collaboration with the Geneva Health Forum.

Image Credits: Vanke School of Public Health , Aaron Jenkins, Sydney School of Public Health, Geneva Health Forum, Paul Palmer/ WHO.

Sugary drinks now face additional taxes in Brazil.

Brazil’s National Congress approved a selective tax on tobacco, soft drinks, and alcohol this week as part of wide-ranging fiscal reform that also saw a reduction in taxes on healthy foods.

The trio of unhealthy consumables is now located in the same tax category as harmful goods and products including coal, vehicles and betting.

The specific tax rates for tobacco, alcohol, and soft drinks will be determined in 2025, but they will need to be high enough to deter consumers from buying these products to have an impact on health. 

The Congressional vote is a victory for advocacy groups as the Brazilian Senate had removed sugary drinks from the selective tax a week earlier, causing a public outcry.

The tax reform also establishes a National Basic Food Basket (CBNA) that will be tax-exempt. Meat, poultry and fish are included in this basket.

In addition, taxes have been slashed by 60% on horticultural and minimally processed goods including crustaceans, dairy products, honey, flour, cereals, pasta, juices, bread, nuts and fruit.

Lowering the price of healthy food

Brazilian legislators and civil society advocates aim to ensure that the prices of healthy foods are not higher than those of ultra-processed and unhealthy products.

 “This is a landmark moment for Brazil and a historic victory for global public health,” said Pedro de Paula, regional country director for the global public health organisation Vital Strategies in Brazil.

“By implementing a tax on these products, Brazil is not only saving lives by curbing the consumption of harmful products but also championing equitable access to healthier, more sustainable alternatives.  We commend Brazil’s National Congress for their leadership in this critical effort.”

De Paul said fiscal reform was necessary as Brazil had a “very complex, clunky system for production and consumer taxes”.

The new selective tax is an excise tax “for a handful of products which had clear negative externalities in terms of health and environment’, he added.

“This is landmark change, since it establishes a system that has clear taxes on top of the general VAT-like taxing structure with a clear narrative and purpose of reducing consumption and internalising the costs of the mentioned negative externalities,” he added.

While the tax will not be ring-fenced for health, De Paulo said that as the health system in Brazil is based on universal and free access, “any additional revenue implies additional minimum investments on health.”

However, Vital Strategies raised concerns about some of the provisions, such as “the inclusion of infant formula in the basic food basket and reduced tax rates for small alcohol producers.”

It will “collaborate closely with partners to advocate for tax rates that prioritise public health”, as “setting these rates at levels that significantly reduce consumption of harmful products will protect communities from preventable diseases.”

Sweetened beverages including soft drinks, artificial juices, and teas are “among the most consumed food groups in Brazil, with an average consumption of 65 litres per year per individual,” according to a recent article in the journal, Nature.

“Excess sugar is considered one of the main causes of excess weight and, consequently, its associated diseases (type 2 diabetes, hypertension). Therefore, the consumption of sugar-sweetened beverages is associated with an increased risk of developing obesity.”

Image Credits: Heala_SA/Twitter.

An Afghan woman amongst ruins caused by ongoing conflict in the country.

Medical institutions were the last hope for Afghan girls and women seeking higher education since the Taliban banned schools and universities for women

“Why do you torture us every day? Just give us poison and end it all,” a heartbroken Afghan medical student told Taliban forces, expressing the despair of thousands of girls whose dreams of becoming healthcare professionals were shattered by the Taliban’s latest decree.

The hardline group has banned all female medical students from pursuing education, marking the closure of nursing and midwifery programs across Afghanistan, the last lifeline for girls seeking higher education in a country where women’s rights have been systematically eroded since the Taliban’s return to power in 2021.

The Taliban’s recent decree, issued directly by the group’s supreme leader, Hebatullah Akhundzada, has caused immediate devastation. 

For the past three years, nursing and midwifery were the only remaining fields of study open to women after the Taliban banned girls from attending secondary schools and universities. The abrupt closure of these institutions has ignited widespread despair across Afghan society.

The ban comes a few months after the Taliban banned women’s voices and faces in public under so-called new vice and virtue laws. 

‘Are we not human?’

The abrupt ban came just days before completion of the last 2024 semester for many aspiring students like Zohra*, a nursing and midwifery student at the Abu Ali Sina Institute in the country’s northern Balkh province.

She told the Health Policy Watch: “These institutes were our last chance to continue our education after schools and universities were closed. I had set a new goal and worked hard, receiving good grades. I was on my way to becoming a midwifery graduate, to help my family, my country, and other women. Now, I’ve truly lost all hope for life.”

Kabul-based Maryam* echoed the despair. “We are Muslims, we observe Islamic hijab, and we just want access to education. Why do they not open the doors of the medical institutes for us? Since the closure of the institutes, I’ve lost track of day and night. I can’t sleep. My parents took me to a psychologist a few times, but nothing is helping. Are we not human?”

‘I have turned homeless’

“I have turned homeless, wandering aimlessly,” one student said in a viral video. Her words, along with others like it, have echoed through Kabul and beyond as girls wearing full-body black veils, many in tears, left their classrooms for the final time, uncertain if they would ever return.

Fariba*, a mother from Kabul, received devastating news when her daughter, Parwana, called early one morning, sobbing uncontrollably. 

“She never calls at this time,” Fariba, who once taught elementary education to girls, told Health Policy Watch. “It’s when she’s in class.” 

Her daughter Sara* had been studying nursing after her dream of attending university to study computer science was dashed by the Taliban’s closure of higher education for girls.

“Now, we are left without hope,” Sara, 20, lamented. “Our dreams are shattered. We are being pushed into the darkness.”

Conservative estimates suggest that around 35,000 girls were enrolled in over 150 private and 10 public medical institutions offering diplomas in fields such as nursing, midwifery, dentistry, and laboratory sciences before the Taliban’s ban. 

These programs were the last available option for young Afghan women who sought to contribute to their communities, particularly in healthcare.

The abrupt suspension has left students in shock. The administrator of one of the nursing institutes sent a message to all female students: “With a heavy heart, I must inform you that until further notice from the Islamic Emirate, you must not come to the institute for studies.”

Deepening health crisis

Training to be a nurse or midwife was the sole remaining career option for Afghan women after the Taliban takeover in 2021.

This move not only marks the end of the academic ambitions of girls and women, but also deepens the country’s already precarious healthcare crisis.

Afghanistan’s healthcare system was already under strain before the Taliban’s return to power, with one of the highest maternal mortality rates in the world. 

In 2020, the country saw 620 women die for every 100,000 live births – a stark contrast to just 10 deaths in the UK, according to the World Health Organization (WHO). 

Less than 60% of births were overseen by trained health personnel in 2019, according to the  United Nations Population Fund (UNFPA), which estimates that Afghanistan requires an additional 18,000 skilled midwives to meet the needs of its women.

Despite the overwhelming need for female healthcare workers, the Taliban’s decision to block access to medical education for women will exacerbate the crisis. 

Médecins Sans Frontières (MSF) warned that the country’s lack of female healthcare professionals would directly impact the provision of essential health services, especially maternal care.

“There is no healthcare system without educated female health practitioners,” said Mickael Le Paih, MSF’s Country Representative in Afghanistan. 

“In MSF, more than 41% of our medical staff are women. The decision to bar women from studying at medical institutes will further exclude them from both education and healthcare.”

The healthcare sector’s reliance on female professionals is especially critical in Afghanistan, where cultural norms often prevent women from being treated by male doctors. 

Dr Ahmed Rashed, a Kabul-based health policy expert, warned that the Taliban’s latest decree would create numerous social challenges, especially for Afghan women who prefer to be treated by female healthcare workers.

“If girls cannot attend secondary school, and women cannot study at universities or medical institutes, where will the future generation of female doctors come from?” Rashed asked. “Who will provide healthcare to Afghan women when they need it most? For essential services to be available to all genders, they must be delivered by all genders.”

International outcry

Last week, the United Nations (UN) Security Council criticized the medical education ban and the “vice and virtue” law issued in August in a unanimous resolution voicing concern about “the increasing erosion” of human rights in the country.

“If implemented, the reported new ban will be yet another inexplicable, totally unjustifiable blow to the health, dignity, and futures of Afghan women and girls. It will constitute yet another direct assault on the rights of women and girls in Afghanistan,” according to UN Special Rapporteurs working on women’s rights, human rights and health. 

“It will undoubtedly lead to unnecessary suffering, illness, and possibly deaths of Afghan women and children, now and in future generations, which could amount to femicide.”

The Norwegian Afghanistan Committee (NAC), which trains female healthcare workers in collaboration with the Ministry of Health, reported that it had been verbally informed that classes for women would be “temporarily suspended.” 

As the Taliban’s gender-based restrictions continue to devastate the lives of millions of Afghan women and girls, the question remains: What is the future of Afghanistan’s healthcare system? Without access to education, Afghan women will be barred from becoming the doctors, nurses, and midwives their country so desperately needs.

This decision, experts warn, will not only create immediate social and healthcare challenges but will have long-term consequences for generations to come.

* Names changed to protect their identities. Updated 22.12.2024.

Manija Mirzaie is an Afghan journalist now based abroad.

 

Image Credits: WHO EMRO, Ifrah Akhter/ Unsplash.

Particles of air pollution settle on the leaves in a south Delhi neighbourhood where the PM 2.5 is  approximately 400 micrograms/cubic metre.

New evidence shows that one in four deaths between 2009 and 2019 is linked to PM 2.5, one of the most dangerous pollutants commonly monitored. 

NEW DELHI – In November Delhi recorded its worst day of air pollution since 2019. As concerned citizens expressed outrage, authorities scrambled for answers – and it seems that the dirty air crisis may be worse than previously reported.

A new study published in The Lancet this week analyses the link between air pollution and deaths in districts (an administrative jurisdiction of a state or province) in India over 11 years from 2009. 

It shows pollution is not just a Delhi problem nor is it a recent problem, estimating that during the time period, 16.6 million deaths are attributable to PM 2.5 pollution. This is the particulate matter pollutant that is much finer than human hair that penetrates deep into the human body. 

The report is timely as the Supreme Court is now expanding the scope of its air pollution hearing from Delhi to cover all of India. 

A south Delhi neighbourhood with PM 2.5 at approximately 400 micrograms/cubic metre.

The study calls for a fundamental rethink of India’s battle against air pollution. Firstly, it shows 24.9% of deaths – almost one in four – are attributable to air pollution, more specifically PM 2.5. 

Secondly, it calls for India’s regulatory standards for air quality to be tightened. The Indian National Ambient Air Quality Standards for annual mean PM2.5 is 40 micrograms per cubic metre (µg/m³) whereas WHO’s guideline is 5 (µg/m³). 

Thirdly, the authors say this report is more relevant to policymakers than previous reports as it is based on data from India. In the past senior Indian government officials have questioned or rejected data linking deaths to air pollution, particularly from global agencies. 

More deaths than previously estimated

The Lancet report found an average of 1.5 million deaths from air pollution between 2009 and 2019, almost a quarter of all deaths.

This is a higher estimate of mortality than earlier studies. For instance, a WHO study reported an average of 830,000 deaths annually in the decade ending 2019, a conservative estimate based on secondary data sources. 

A study for 2019 by the Indian Council of Medical Reseach (ICMA), a government agency, and others estimated 1.7 million deaths. The new study tops that with 1.8 million attributable deaths for that year.

Applying the more relaxed guideline of 40 µg/m³ for PM 2.5 set by the Indian government, the number of deaths is estimated by the Lancet report to be 3.8 million over 11 years, or 300,000 every year. 

The entire population of India breathes air of a quality worse than the WHO’s guideline for an annual average.

New data is ‘more credible’ 

While there have been several large-scale studies globally on the link between PM 2.5 air pollution and deaths, this is the first such one in India which in recent years has the most polluted places. 

One of the authors, Dr Siddhartha Mandal, told Health Policy Watch that studies usually make associations between exposure to PM 2.5 and mortality. However, this report “lends more credibility” to the numbers because it uses a difference-in-difference approach to reach causal estimates. This methodology compares the changes in outcomes over time between a treatment group and a control group.

(A) Annual mean concentrations of PM2·5 in 2009. (B) Differences in annual concentrations in 2014 compared with 2009. (C) Differences in annual concentrations in 2019 compared with 2009.

“We believe that our study provides the most accurate exposure-response function and health impact assessment in India to date based on causal estimations from a state-of-the-art comprehensive exposure assessment and nationwide mortality data collected in India,” according to the authors.

It covers air pollution across 655 districts of India. The authors collected and analysed national counts of annual mortality for the 11 years, and also factored in the population and GDP per capita for each district. 

The authors say they observed stronger associations between annual PM2.5 averages and mortality in poorer districts (in terms of GDP).

Risk of death rises with pollution

In a country racked by an air pollution health crisis, there is one pressing figure for policymakers. Every 10 microgram/cubic meter increase in PM 2.5 leads to an increase in all-cause mortality rates by 8.6%, the study estimated. 

PM2·5 concentration is shown up to the 99th percentile.

While the AQI at 500 or 1,000 grab headlines, what the research points out in terms of health risks at lower levels is an eye-opener. 

“As the exposure levels increase, a plateauing effect is seen where, if you keep increasing the levels, additional increments in health are likely to be small,” says Mandal, who is affiliated with the Centre for Chronic Disease Control, New Delhi, and the Centre for Health Analytics and Trends, Ashoka University.

Simply put, that means that the risks rise from much lower levels of PM 2.5, when many thought the air quality was fine, but as the levels become extremely high, the risk may plateau or taper. 

How PM 2.5 harms humans

“Due to its size, PM 2.5 can enter the bloodstream and hence gets transported to multiple organs,” Mandal explains.

“Thereafter several common mechanisms such as inflammation and oxidative stress are triggered or exacerbated in the tissues.

“One of the major ways by which PM2.5 affects cardiovascular health is by inducing an imbalance in the autonomic nervous system, which controls several involuntary functions in humans such as cardiac rhythm. So PM2.5 contributes in multiple ways leading to exacerbation or acceleration of these conditions and subsequently death.”

A few days before this report was published, the Indian government reiterated in Parliament that “there are no conclusive data available in the country to establish direct correlation of death/disease exclusively due to air pollution.

“Health effects of air pollution are synergistic manifestation of factors which include food habits, occupational habits, socioeconomic status, medical history, immunity and heredity etc. of the individuals.” 

However, the authors say that policymakers could first take stock of all the recent work done relating air pollution and health (including mortality) using Indian data.

Experts from multiple domains, including public health, clinicians and engineering disciplines can deliberate on how to incorporate health-related evidence into designing interventions, mitigation strategies as well as revision of air quality standards. 

In parallel, there should be targeted actions backed by scientific evidence in the short and long-term, rather than reactive actions. For example, one could design and test out a public transport based intervention in certain areas within Delhi to assess how it affects pollutant levels across time. 

But they say, “most importantly, we should not wait for a perfect study to emerge and rather utilise available national as well as international evidence to take steps to improve the quality of air in the context of health.”

Image Credits: Chetan Bhattacharji, The Lancet.

Lenacapavir, packaged as Sunlenca in the US, where is sellas for $42,250 for two injections.

Some two million people may get access to lenacapavir, the twice-yearly antiretroviral injection that prevents HIV injection, within the next three years, thanks to the Global Fund and United States President’s Emergency Plan for AIDS Relief (PEPFAR).

The initiative is contingent upon regulatory approval from the US Food and Drug Administration (FDA), national pharmaceutical regulators, and a recommendation from the World Health Organization (WHO).

It is being supported by the Children’s Investment Fund Foundation (CIFF) and the Bill & Melinda Gates Foundation (BMGF) 

At present, lenacapavir is licensed in the US and other countries as a treatment for adults with drug-resistant HIV. 

However, in two clinical trials it has shown to almost completely block HIV when used as pre-exposure prophylaxis (PrEP).

Not a single one of the 2,138 women in PURPOSE 1 trial who received lenacapavir contracted HIV. In the PURPOSE 2 trial involving men and gender-diverse people, only two of the 2,179 participants became infected during the trial – a success rate of over 99%.

In both trials, lenacapavir was tested alongside oral PrEP and found to be superior as the twice-a-year injection is much easier to adher to than taking daily pills.

“We cannot reach a sustainable HIV response without rapidly reducing the 1.3 million new HIV infections that occur worldwide every year,” said Ambassador Dr John Nkengasong, US Global AIDS Coordinator head of PEPFAR in a statement on Tuesday.

“Lenacapavir offers a potentially tremendous opportunity to transform the impact of HIV programs to ensure adolescent girls and young women, key populations, and others who could benefit have access to highly effective HIV prevention, testing and treatment services and to end HIV/AIDS as a public health threat by 2030.”

In October the medicine’s manufacturer, Gilead, announced that it had signed non-exclusive, voluntary licensing agreements with six pharmaceutical companies to manufacture and supply generic versions of lenacapavir for 120 primarily low- and lower-middle-income countries.

Global regulatory filings

“Data from both PURPOSE 1 and PURPOSE 2 will support a series of global regulatory filings for lenacapavir for PrEP that will begin by the end of 2024,” Gilead announced.

The FDA has granted lenacapavir for PrEP “breakthrough therapy designation”, which is intended to expedite the development and review of new drugs that may demonstrate substantial improvement over available therapy.

The FDA has also granted a “rolling review” for lenacapavir for PrEP, which allows the FDA to fast-track the review of a drug application by allowing a company to submit sections of the application for review as they are completed.

In September, WHO announced that it is “working rapidly to convene a guideline development group with experts, ministries, partners and communities”.

This group will develop and issue guidelines based on a “rigorous assessment of the potential of lenacapavir for HIV prevention, evaluating key aspects such as efficacy, safety, cost-effectiveness, values and preferences from stakeholders and communities, and global scalability, among others”.

A WHO spokesperson told Health Policy Watch on Tuesday that the Guideline Group meeting will be held from 28-30 January and would have a recommendation by July 2025, at the latest.

“WHO has already listed lenacapavir on the Expression of Interest list (EOI) and has provided guidance on bioequivalence,” the spokesperson added.

It is also working to ensure rapid regulatory approval via the FDA and European Medicines Agency EMA Medicines4All pathways.

Once a Stringent Regulatory Authority (SRA) approval is obtained, the manufacturer can apply for pre-qualification using the abridged pathway.

“WHO is working with potential early adopter countries to anticipate and prepare for guidelines and country regulatory approvals,” the spokersperon said.

Excited by the promise

“At the Global Fund, we are incredibly excited by the promise of lenacapavir and its potential to help us achieve a further significant reduction in new infections among individuals at high risk of acquiring HIV,” said Peter Sands, Executive Director of the Global Fund. 

“As part of this coordinated effort, the Global Fund, PEPFAR, CIFF, and BMGF will work with Gilead and the voluntary licensing manufacturers to accelerate affordable and equitable access, so that more people can benefit from this powerful innovation from day one.”

CIFF founder and chair Sir Chris Hohn, said that innovations like lenacapavir can profoundly impact the lives of millions.

“It will be a travesty if the communities who need it most don’t have access. That is why this collaboration is so essential to ensure that lenacapavir is available as soon as possible for those who need it the most,” said Hohn.

Image Credits: Gilead.

Médecins sans frontières (MSF) teams prepare to distribute mosquito nets to protect against mosquito bites during a health fair in vulnerable communities in Anzoátegui state, Venezuela.

Climate change, unplanned urbanization, sprawling cities, and the El Nino effect all converged to make 2024 a “historic” year for dengue transmission. With increased opportunities for Aedes aegypti mosquitoes–the insects that carry dengue– to breed, cases reached a record 12.7 million cases in the WHO’s Americas Region, nearly three times more than in 2023.

This translates to roughly 21,000 severe cases and over 7700 deaths across northern, central and southern regions of the continent.  And more than a third of the severe cases occurred in children, warned Dr Jarbos Barbosa, Pan-American Health Organization (PAHO) Director, in a press conference last week. 

“In countries like Guatemala, 70% of dengue-related deaths have occurred in children,” Barbosa noted. Barbosa’s home country of Brazil accounted for nearly 80% of cases in the Americas, followed by Argentina, Colombia, and Mexico. 88% of deaths from dengue occurred in these four countries.

At the close of this historic dengue season, Pan-American Health Organization (PAHO) leadership discussed reasons for the surge in cases, and the tools to combat next season’s caseload. Of concern is the geographic expansion of dengue-susceptible regions into countries like Argentina, Uruguay, and the United States. “This increase in cases is directly associated with climate events, including droughts, floods, and warmer climates that favour the proliferation of mosquito breeding sites,” said Barbosa. The director also cited population growth, unplanned urbanization, poor living conditions, and inadequate water supply and waste disposal as major drivers of dengue transmission. 

“Despite these challenges, we are not defenseless,” argued Barbosa. Vector surveillance, improved case management, community engagement, and the rollout of dengue vaccines in targeted populations have meant PAHO is optimistic about next year’s season. “We don’t have a crystal ball,” said Dr Sylvian Aldighieri, PAHO director of the Department of Prevention, Control, and Elimination of Transmissible Diseases, referring to 2025 projections. But because 2024 had such high transmission rates, much of the population has now acquired immunity to the most prevalent serotypes, he noted. 

Migrants at risk of dengue and other diseases – gaps in data and health care coverage are challenges

Migrants in Darien Gap Panama
Over half a million migrants passed through the Darien Gap in 2023. “A vulnerable population” according to PAHO, migrants face a host of health challenges.

While dengue is typically characterized as an urban disease–where mosquitoes breed in discarded plastic bottles and sidewalk puddles, the large migrant population moving through central America to southern and central Mexico [Mesoamerica] towards the United States, is also especially vulnerable to infectious diseases.

“This is a big throughway for persons,” noted Dr Thais dos Santos, Regional Advisor on Surveillance and Control of Arboviral Diseases, in response to a Health Policy Watch query. “Dengue surveillance has a long tradition in the region of the America, but as it evolves, we realize that there are some data gaps.” Healthcare facilities do not typically collect information on a patient’s migrant status, meaning there is limited data to understand the burden of dengue in migrants. Dos Santos cautioned, thus, that PAHO has limited data to understand the scope of migrant health statuses, especially with regard to vector-borne diseases.

Dengue is not the only communicable disease of concern for migrants. “We are assisting countries in preventing any reintroduction of malaria that can be spread through the flow of migrants,” said Dr Andrea Vicari, PAHO Head of the Infectious Hazard Management Unit. “It’s a population at risk, living in very vulnerable conditions,” Vicari noted. 

Strengthening migrant health remains a PAHO priority, as record-breaking numbers of asylum-seeking migrants traverse the Darien Gap through Panama. The year 2023 saw more than half a million people transit through Mesoamerica en route to the United States. This population is burdened by a host of health threats, including sexual and gender-based violence, food insecurity, HIV, and malaria. PAHO’s November 2024 migrant health report called for increased access to emergency, maternal, pre and postnatal, and mental health services. 

Oropouche, avian flu emerge as new threats in 2024

PAHO leadership arboviruses
PAHO Arbovirus Panel (From left): Dr Andrea Vicari, Dr Sylvain Aldighieri, Dr Jarbas Barbosa, Dr Thais dos Santos.

While dengue contributed to the largest burden of mosquito-borne diseases, PAHO leadership also brought attention to Oropouche, a rare but increasingly circulating virus in the Americas. The year 2024 saw nearly 12,000 cases, mostly in Brazil, representing a dramatic increase since last year. The virus, an arbovirus like dengue, Zika, and chikungunya, is spread through bites by certain midge mosquitos. Oropouche symptoms are similar to these other arboviruses with fever, rashes, muscle aches, and headaches common. Symptoms typically last 5 to 7 days, but more recently, the virus has been linked to severe fetal outcomes, including congenital abnormalities and death. 

Notably, cases were seen in regions not typically associated with the disease, mirroring dengue’s march into new geographic areas.  Brazil also reported several instances of transmission from mother to child earlier this year, with 8 cases of infant microcephaly and fetal death, causing the US Centers for Disease Prevention and Control (CDC) to issue travel warnings for pregnant women to the affected regions in the country. 

PAHO leadership also provided an updated report on the ongoing H5N1, or avian flu, outbreak in North America. The United States has already reported 58 human cases, mostly poultry and dairy workers, while in Canada a teenager with no known contact with infected birds or cattle also fell ill recently – reviving longstanding concerns about new virus mutations that could facilitate more human-to-human transmission.

“Surveillance, including genomic characterization, is crucial to track the virus across species, understand its evolution and risks to humans, and guide our actions,” said Barbosa. The director argued that intersectoral collaboration with a One Health approach is critical – as this influenza strain has now jumped to dairy cows for the first time, meaning that measures to reduce animal exposures as well as to protect people must be addressed together.

Also among the longstanding WHO recommendations is the pasteurization of milk to contain the public health risk. “The pasteurization of the milk has been described and used for the last 150 years. This is one of the great achievements of the public health sector…with pasteurized milk, we should not have any major issues of transmission of this disease to people,” mentioned Dr Vicari.

“Countries must strengthen their surveillance and continue sharing information. We must work across borders to monitor new cases and support health systems to respond,” emphasized Barbosa.

Image Credits: Matias Delacroix/MSF, PAHO/WHO, PAHO/WHO/David Spitz.

A Mexican study has found that younger people are more vulnerable to heat, possibly because they spend more time working outside.

Some 75% of heat-related deaths occurred amongst people under the age of 35 , and one-third of such deaths were young adults between the ages of 18 to 35, according to a new study on heat mortality in Mexico.

This contradicts previous assumptions that the elderly are the most vulnerable to heat.

“We project, as the climate warms, heat-related deaths are going to go up, and the young will suffer the most,” said R. Daniel Bressler, a PhD candidate in Columbia’s Sustainable Development program and co-lead author of the study, published in Science Advances.

“It’s a surprise. These are physiologically the most robust people in the population,” said the study’s co-author Jeffrey Shrader  from the Center for Environmental Economics and Policy, an affiliate of Columbia University’s Climate School in New York City. “I would love to know why this is so.”

The researchers speculate that several factors may be at work. Young adults are more likely to be engaged in outdoor labour including farming and construction, and thus more exposed to dehydration and heat stroke. Young adults are also more likely to participate in strenuous outdoor sports, the researchers pointed out.

Infants and children under the age of five are also particularly vulnerable to heat as their bodies are not yet efficient in regulating temperature. Deaths of infants and young children, together with those aged 18-35, made for 75% of all heat-related deaths.

Meanwhile, people in the 50 to 70 age bracket suffered the least amount of heat-related mortality to the surprise of researchers.

Using the same daily temperature and mortality data, the researchers found that elderly people were at a higher risk of dying from modest cold, as compared to heat, at least in the Mexican context. Mexico is mainly tropical and subtropical country, but it has many climate zones including high-elevation areas that can get relatively chilly.

Younger people do most manual, outdoor labour

The new study has global implications, said the team of researchers, who along with Shrader, are mostly affiliated with Columbia, as well as Boston University, Stanford and the University of California. Many poor, hot countries, mainly in Africa and Asia, have young populations, with a large proportion working in manual and outdoor labour.

The retrospective analysis assessed heat-related deaths over a twenty-year period, from 1998 to 2019. For individuals under 35, heat causes 2.6 times more deaths than cold whereas for individuals 35 and older, cold causes 56 times more deaths than heat.

Children under five, especially infants, also had a disproportionate number of heat-related deaths, although not as large. Overall, people under 35 years accounted for 75% of historical, heat-related deaths, the researchers found.

Historical and projected annual deaths due to heat and cold exposure by age group in Mexico. Among adults, people aged 18-35 had by far the highest risk of death from heat exposure (top), with infants and children under 5 close behind.

A previous separate analysis by primarily Mexican researchers showed that death certificates of working-age men were also more likely to list extreme weather as a cause than those of other groups.

“These are the more junior people, low on the totem pole, who probably do the lion’s share of hard work, with inflexible work arrangements,” said Shrader.

The vulnerability of infants and small children came as somewhat less of a surprise. It is already known that their bodies absorb heat quickly, and their ability to sweat, and therefore cool off, is not fully developed. So exposure to temperatures that exceed their body temperature can be rapidly fatal.

Their immune systems are also still developing, which put them at higher risk of ailments that become more common with humid heat, including vector-borne and diarrhoeal diseases.

The researchers reached their conclusions by correlating excess mortality or the number of deaths above or below the average, with average temperatures in the same period, on the “wet-bulb scale” that reflects he magnified effects of heat when combined with high levels of humidity.

Despite being based mostly in the USA, the researchers y chose Mexico for the study because it collects highly granular geographical data on both mortality and daily temperatures.

Older people more likely to die of cold

Older people tend to have lower core temperatures, making them more sensitive to cold. In response, they may be prone to staying indoors, where infectious diseases spread more easily.

Despite all the attention given to the dangers of global warming, other extensive research has generally suggested that to date, excessive cold exposures, not heat, are currently the world’s number one cause of temperature-related mortality, including in Mexico. However, the proportion of heat-related deaths has been climbing since at least 2000, and this trend is expected to continue.

Around 4.1 billion people or roughly half the world’s population has experienced unusually hot temperatures between June and August this year, according to a report from US-based non-profit Climate Central.

Deaths occurred at lower-than-expected heat levels

There is a widespread recognition that temperatures alone are not a good measure of the impact of heat but “wet bulb temperatures” that also factors in humidity, are. Essentially, the same temperature level in conditions of high humidity is more dangerous than at low-humidity because humid conditions reduce the absorption of sweat, which cools off the body.

Wet bulb temperatures are often referred to as the “real-feel” heat indexes where numbers can vary depending on the exact combination of heat and humidity.

Previous research has suggested that workers begin to struggle when wet-bulb temperatures reach about 27°C, which would equate to 86 to 105°F, depending on humidity. However, the new study found that the largest number of deaths occurred at wet-bulb temperatures of just 23 or 24°C, in part because those temperatures occurred far more frequently than higher ones, and thus cumulatively exposed more people to dangerous conditions.

A study published last year showed that farm workers in many poor countries are already planting and harvesting amid increasingly oppressive heat and humidity.

Bressler, the report’s lead author, said the team is now looking to firm up its conclusions by expanding its research into other countries, including the United States and Brazil.

Image Credits: Unsplash, Study: Heat disproportionately kills young people: Evidence from wet-bulb temperature in Mexico.

The International Court of Justice in the Hague heard arguments from the WHO Director-General on Friday in a landmark case on climate justice.

Climate change poses an immediate and catastrophic threat to human health worldwide, the World Health Organization (WHO) chief warned the UN’s highest court on Friday as it considers a landmark case that could establish fresh legal obligations for nations to cut emissions and pay for climate damages.

WHO director-general Dr Tedros Adhanom Ghebreyesus testified to the International Court of Justice (ICJ) that climate change is “fundamentally a health crisis” that is already “wreaking havoc” on human health, societies, economies, and overwhelming healthcare systems worldwide.

The case, brought by the Pacific island nation of Vanuatu, represents the largest in ICJ history, with nearly 100 countries and organizations participating. While the court’s advisory opinion, expected next year, will not be binding, legal experts say the ruling could strengthen climate litigation worldwide. For small island nations, the stakes are existential – climate models predict many will disappear beneath Pacific waters without dramatic cuts to global emissions.

“The climate crisis is among the most significant health challenges facing humanity today,” Tedros told the court. “It is not a hypothetical crisis in the future. It is here and now. Without immediate action, climate-related increases in disease prevalence, destruction of health infrastructure, and growing societal burdens could overwhelm already over-burdened health systems around the world.”

The UN health chief highlighted how climate change is already altering disease transmission patterns for infections like malaria, dengue and cholera, while extreme weather events are destroying health infrastructure and claiming thousands of lives. Tedros also emphasized that noncommunicable diseases, including cancers and cardiovascular conditions, are linked to climate change and air pollution.

An estimated 920 million children currently face water scarcity, a situation he warned would worsen as climate change intensifies droughts and contaminates water supplies. Rising temperatures are also increasing heat-related deaths and illnesses. Tedros further articulated fears of massive population displacement and projected that over 130 million people could be pushed into extreme poverty by 2030, with devastating impacts on health.

“Millions are expected to be pushed into poverty. This will dramatically increase health burdens and disparities,” he said. “Not enough is being done…to avoid the most catastrophic impacts related to climate change.”

‘Health at the centre’

Iririki Island, Vanuatu.

The WHO chief criticised “massive fossil fuel subsidies,” citing International Monetary Fund projections that appropriate fossil fuel pricing that includes health and environmental costs could prevent 1.2 million air pollution deaths annually. The UN health agency estimated last month ahead of COP29 in Baku meeting climate targets could save two million lives a year.

“The value of health improvements from mitigation significantly outweighs the costs,” Tedros said. “The failure to respond to climate change is undoubtedly the most costly approach.”

WHO’s chief legal counsel Derek Walton urged the court to place health considerations at the center of its advisory opinion, emphasizing that “science and technical evidence should be at the heart of the court’s consideration.”

“WHO respectfully requests the court to place health at the center of its advisory opinion, and in this regard, to give full effect to the fundamental right of every human being to the highest attainable standard of health,” Walton said.

Walton further cited precedents in ICJ rulings that consider health as a human right, pointing to the court’s 1996 ruling on nuclear weapons.

“As the court stated nearly three decades ago in its advisory opinion on nuclear weapons, the environment is not an abstraction, but represents the living space, the quality of life and the very health of Human beings, including generations unborn,” Walton said. “We respectfully ask you to allow the science and the technical evidence to guide your analysis.”

Out of the COPs and to the courts

COP 29 in Baku, Azerbaijan

The proceedings come just weeks after December’s UN climate summit in Baku ended without meaningful commitments on emissions cuts or climate finance, even as global carbon dioxide emissions hit record highs and 2024 is confirmed as the hottest year on record.

Throughout the two-week proceedings in the Hague, which concluded on Friday, major emitters pushed back against the ICJ’s jurisdiction in the case. China urged the court to defer to existing UN climate mechanisms as “the primary channel for global climate governance,” while Saudi Arabia insisted national climate pledges represent only “an obligation of best efforts, not of results.” The United States and several EU members similarly argued existing treaties should be sufficient.

Low-lying islands, several of which called the outcome at COP29 a death sentence, argued the failure of current UN climate instruments is precisely why this case is before the court.

“We’ve heard much about the Paris Agreement as being the solution, but the reason why the climate-vulnerable states have come before the court is that the Paris Agreement has failed,” said Payam Akhavan, counsel for small island states, pointing to projections of 3.1C warming by century’s end.

Small islands represent just 1% of the global population, economy and emissions, but face existential threats from rising seas. In his remarks, Tedros recounted meeting a boy, Falou, on the island of Tuvalu five years ago who shared discussions with friends about what they would do if their island disappeared.

“They worry about the survival of their island homes due to the emissions produced by distant nations,” he said. “This reality weighs heavily on their young shoulders.”

Falou’s island home is projected to be the first nation to disappear beneath the waves. “Tuvalu will not go quietly into the rising sea,” its representative Philippa Webb told the court on Friday.

The court’s opinion, which small island states and developing countries hope to leverage in climate lawsuits worldwide, is expected in 2025. Though not legally binding, the ruling will carry significant moral and legal weight, legal experts say.

“States’ long-standing duties to prevent transboundary environmental harm and human rights violations, including from climate change, did not begin with the UNFCCC or the Paris Agreement, and they do not end with any COP deal,” said Nikki Reisch, director of the Climate and Energy Program at the Center for International Environmental Law (CIEL).

“The ICJ can and must make clear that when States breach their climate obligations, and harm ensues — as it so evidently has — they must right the wrongs,” Reisch said.

Kathmandu has introduced air sensors to monitor pollution.

More than one-third of countries worldwide lack government-level air quality monitoring, leaving nearly one billion people in the dark about one of the greatest risks to their health, a new report showed on Friday.

The assessment by non-profit OpenAQ, which maintains the largest open-source database of air quality measurements, found significant gaps in government tracking and sharing of air quality data, particularly in low and middle-income countries. The biennial report is the only global assessment of whether and how national governments are producing and sharing air quality data with the public.

Thirty-six per cent of countries provide no government monitoring of air quality, with 90% of people in nations without monitoring programs living in low and lower-middle-income countries, where the World Health Organization (WHO) says higher pollution levels and disease rates make populations especially vulnerable. A further 9% of countries do collect government air quality data but do not share it publicly, widening the gap of public access to this critical health threat even further.

Air pollution ranks as a leading cause of death and disability in all the most populated countries without monitoring, including the Democratic Republic of Congo, Tanzania, Afghanistan and Iran. Progress in expanding monitoring remains slow, with only a 3% increase in countries conducting national or subnational air quality monitoring since 2022.

“In order to deliver clean air for all, governments need to not only track air quality, but also offer an accessible, quality data set,” said Dr Colleen Rosales, OpenAQ’s Strategic Partnership Director. “Billions of people do not know what they are breathing and could benefit from greater data transparency.”

Air pollution, mainly from fossil fuel emissions, kills more than eight million people annually and costs over $8 trillion worldwide, making it the largest environmental health risk. Its impact on life expectancy matches that of smoking and exceeds that of alcohol use, transport injuries and HIV/AIDS.

Exposure to pollutants in the air affects health from birth, causing respiratory diseases, cardiovascular problems and developmental issues, with babies, young children and low-income communities facing the greatest risks. WHO data shows 99% of people worldwide breathe unhealthy air every day.

Transparent data would benefit billions 

While NGOs, academic institutions and private companies monitor air quality, government data provides unique value through continuous, comprehensive measurements. Unlike time-limited studies, government monitoring tracks a wider range of pollutants, supporting regulatory compliance, legal proceedings, health research, pollution tracking and air quality forecasting.

Only 55% of governments share their air quality data publicly, with just 27% providing it in a fully transparent and accessible format, the report found. Countries facing major air pollution crises that continue to lack transparency include China, Russia, India, Pakistan, and seven other major nations with populations of at least 70 million people.

“While many populous countries have partially shared their air quality data, an increase in transparency could benefit over 4.5 billion people,” the report said. “Barely over one-quarter of countries provide full and easy public access to data detailed enough to inform scientific inquiry and pollution reduction policies.”

Air Quality Indexes (AQI) vary widely between countries, leading to inconsistent messaging to the public about the risks of pollution levels.

Countries lacking transparent reporting frequently rely on Air Quality Index (AQI) systems that vary widely between nations, often triggering different health warnings for the same pollution levels and confusing communication with the public. While these help with daily decision-making, they lack the detailed measurements scientists and policymakers need for research and regulation.

India and Pakistan illustrate the data transparency challenges, even as their cities rank among the world’s most polluted. Both countries share air quality data only in “static, non-machine-readable formats” like PDFs and graphics rather than analysable datasets, the report said. Last month, Delhi suspended schools and construction as pollution reached twenty times WHO’s safe limit, while Lahore recorded its highest-ever levels. The severity of the crisis has forced long-time rivals toward cooperation, with Pakistan’s Punjab province seeking unprecedented talks with India.

“Although sharing data as a PDF or graphic is a good first step, when data are provided in a machine-readable, analysis-ready and standardized form, many more use cases—and ultimately, impact—can be derived from the data,” the report found. “In the quest for clean air for all, we appeal to all governments to offer data-transparent air quality monitoring versus only the 27% that do so today.”

Some nations have made progress, with 30 countries improving their monitoring or transparency since 2022. Eleven countries, including Japan, Italy and Kenya, achieved full transparency in that period.

Barriers to monitoring

Three-wheelers trapped in smog in Lahore, Pakistan in late November, 2024

Nearly one billion people live in countries without air quality monitoring, but government inaction isn’t always the cause. Many nations, particularly low- and middle-income countries, lack the financing and technical expertise to implement monitoring systems. A 2022 Clean Air Fund survey found one-third of 119 countries could not establish monitoring networks due to these constraints.

The report suggests increased investment could quickly expand monitoring, but funding remains scarce. Only 0.5% of development aid and 0.1% of philanthropic funding targets clean air initiatives. Health programs linked to climate change – a key driver of mounting air pollution deaths – receive just 2% of adaptation funds and 0.5% of multilateral climate funding.

War and civil conflict have also disrupted monitoring efforts. Air quality monitoring systems have collapsed amid wars in Ukraine and Palestine, while ongoing civil conflict in Sudan has prevented any progress on building air surveillance infrastructure.

Beyond disrupting measurement systems, warfare itself creates severe pollution. Millions of bullets, grenades, bombs and missiles detonated in Ukraine during Russia’s ongoing assault led to an abrupt spike in air pollution across Europe, with around a 10% increase in harmful pollutants such as PM2.5 and NO2 in cities near the fighting.

The health impacts of air pollution in war zones are also likely underestimated, according to research from the International Union Against Tuberculosis and Lung Disease. Even small increases in pollutants significantly raise hospitalization risks for cardiovascular and respiratory conditions, while war zones face multiple simultaneous pollution sources and populations under extreme stress, weakening their response to environmental hazards.

“In a war zone, air pollution is likely to result in more deaths than bombs,” the Union found.

Image Credits: Partnership for Health Cities.