Members of the trade union, PSLink, protesting outside the Philippines Supreme Court. The union petitoned the court to win increases for nurses.

Countries are most likely to have laws about health workers’ pay and least likely to provide them with mental health services and protection against discrimination.

There is also little correlation between a country’s wealth and the protection it offers its health workers.

These are some of the findings of a study of over 1,200 laws relating to health and care workers from 182 countries led by the O’Neill Institute for National and International Health Law and the World Health Organization (WHO).

Researchers examined the countries’ laws to see how well they aligned with the Global Health and Care Worker Compact adopted by the World Health Assembly in 2021.

The Compact was introduced to provide countries with guidelines to protect their health and care workers – a response both to the huge price health workers paid during COVID-19 and the growing shortages of health workers.

Over 115,000 health workers were estimated to have died from the virus by the time the Compact was adopted, while there is a global shortage of over 10 million health workers.

Significant gaps

The research identifies key areas where governments can use law and policy to safeguard health workers’ rights, promote and ensure decent work free from discrimination, and a safe and enabling working environment.

Around 62% of the laws were aligned with the Compact, according to Matt Kavanagh, Director of the Center for Global Health Policy and Politics at the O’Neill Institute.

“Our analysis shows significant gaps. Nearly every country has multiple areas where national laws are not yet aligned with the Care Compact, although alignment is feasible,” Kavanagh told a media briefing on Tuesday. 

The findings were published in Plos Global Health on Monday and details about the countries’ laws are available on a dedicated website that will serve as a baseline 

“While 69% of countries have some form of health services guaranteed for health workers, only 20% of those ensure that mental health and well-being are covered,” Kavanagh noted.  Twelve percent of countries had zero provision for health for healthcare workers.

“This analysis highlights the need for, and opportunity of, law reform in countries throughout the world to elevate and protect the rights and well-being of health and care workers and, in doing so, improve health systems,” noted Kavanagh.

With 105 countries aligned to half of more of the Compact’s recommendations, Kavanagh  described the report as “half-full”.

“Law reform is a key piece of what might drive us toward better retention and better effectiveness of our health and care workforces.”

One of th biggest gaps is that community health workers are usually not protected and often do not earn even the minimum wage.

Speakers at the launch of research on the protection of healthworkers (L to R): Atul Gawande, Matt Kavanagh, Catherine Kane (moderator), Laetitia Rispel, Jillian Roque and Jim Campbell

Health workers ‘are the health system’

Dr Atul Gawande, Assistant Administrator for Global Health at USAID, described the research as “transformative” as it provides both a baseline for countries to assess themselves against the Compact as well as the capacity to track progress.

“When we are talking about plans for strengthening systems, what we’re really talking about are plans for strengthening health workers. ‘Systems’ is abstract. Health workers are the system,” said Gawande. USAID assisted in funding the research.

Jim Campbell, Director of the WHO’s Health Workforce department, said the research marked a move “beyond political will into evidence-based policy”.

“Health systems are under huge challenges – population, ageing, conflict, humanitarian disasters, climate disasters. These are being transferred to the health and care workers worldwide,” he added.

With an estimated shortage of around 11 million health workers, “health systems will not have the capacity to respond to the demand, transferring a burden onto the workers that we seek to protect,” said Campbell.

“The first action has to be to invest in today’s workforce to seek those protections.”

Sub-optimal working conditions

Professor Laetitia Rispel from the School of Public Health at the University of the Witwatersrand in South Africa noted that slightly more than half of African countries had laws aligned with the Compact.

Yet Africa is going to be one of the worst affected by health worker shortages, Rispel noted.

“Sub-optimal working conditions, which are often most acute in the region, often serve as a push factor for health workers to migrate,” she warned.

Trade unionist Jillian Roque, Chief of Staff at the Public Services Labor Independent Confederation (PSLink) in the Philippines, also decried the “persistent gaps” in the protection of healthcare workers’ rights.

“In many areas, public health care workers are denied their fundamental rights to freedom of association and collective bargaining,” Roque said.

PSLink is part of the global federation of public sector workers, Public Services International (PS), which is fighting for “fair pay, decent work, equality and non-discrimination” through organising unions, said Roque. 

In the Philippines, unionists have been killed, harassed and “red-tagged” [labelled as communists], making it one of the 10 worst countries for workers in the world, she added.

Despite this, PSLink has successfully ensured the ratification of important conventions on occupational health and safety, the elimination of violence and harassment in the workplace and compelled the government to raise the salaries of nurses after filing a petition at the Supreme Court. 

Campbell noted that two-thirds of the global health workforce (67%) is women and this is often linked to the lack of protections.

Image Credits: Sophie Mautle/HeDPAC , PSLink.

A Ghanaian child receives a  malaria vaccine, which has been credited with reducing deaths in children since its introduction.

New WHO Global Malaria Report points to funding shortfalls, climate change, and antimicrobial resistance as key challenges to control.

Last year saw 263 million new malaria cases and 597,000 deaths in 83 countries worldwide, an increase of almost 11 million cases from the prior year, according to the World Health Organization’s (WHO) newly-released Global Malaria Report. The vast majority of cases occurred in the African continent, with children under five bearing the greatest burden of malaria mortality. 

Targeted interventions like insecticide-treated bed nets and integrated vector management, alongside factors such as improved nutrition, housing, and urbanization, have all reduced malaria transmission and disease in the past decades. More than 177 million cases and 1 million deaths were averted globally in 2023, and Egypt was declared malaria free, a significant milestone for Africa’s third-most populous country, according to the WHO.

Yet despite progress made in reducing the spread of the ancient disease, challenges like climate change, humanitarian crises, drug resistance, and persistent disparities all threaten global malaria progress. 

“Instead of dying, mosquitoes are dancing on the treated bed nets,” said Dr Michael Charles, CEO of RBM Partnership to End Malaria, referring to the growing number of mosquitoes resistant to commonly-used insecticides. 

Malaria burden per country in 2023

The number of new malaria cases actually increased in the past years, the report notes. Malaria case incidence – the number of new cases while accounting for population growth – grew from 58 to 60.4 cases per 1000 between 2015 and 2023. Five countries accounted for the majority of this increase in cases: Ethiopia (+4.5M), Madagascar (+2.7M), Pakistan (+1.6M), Nigeria (+1.4M) and Democratic Republic of Congo (600K). 

The WHO presented its newly-released report on the global state of malaria as a combination of both hard-fought victories, and obstinate and emerging challenges ahead of key replenishment rounds next year.

“No one should die of malaria; yet the disease continues to disproportionately harm people living in the African region, especially young children and pregnant women,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

“An expanded package of lifesaving tools now offers better protection against the disease, but stepped-up investments and action in high-burden African countries are needed to curb the threat.”

 

Africa ‘not on pace’ to meet WHO target

The Africa region bears the brunt of the global malaria burden – both in the number of cases and deaths – with 11 countries accounting for two-thirds of cases worldwide. Nearly half of these deaths occurred in just four countries: Nigeria (30.9%), Democratic Republic of the Congo (11.3%), Niger (5.9%), and United Republic of Tanzania (4.3%). 

Over 75% of deaths in the African region were among children under the age of five. Progress to reduce malaria mortality has barely budged in the past decade. The 2023 malaria mortality rate of 13.7 deaths per 100,000 people at risk was more than twice the WHO global strategy target of 5.5. 

While these rates remain high, many African countries have either stabilized or reduced their mortality rates. Dr Mary Hamel, WHO Team Lead for Malaria Vaccines, credits this to vaccinations for children in conjunction with bed nets and other interventions. 

“The vaccine is recommended by the WHO from five months of age, and during the pilot implementations where the governments of Ghana, Kenya, and Malawi introduced the vaccine …we saw high impact from these young age periods, with reduction in all cause mortality in these young children by 13% in all cause mortality.”

Seventeen countries have since introduced the malaria vaccine alongside childhood immunizations, with supply so far sufficient to meet demand.

WHO goals for malaria mortality rates (green) and projected rates under the status quo (blue).

Climate change, conflict, biological threats undermine progress

The many climate change-related disruptions in rising temperatures and changing weather patterns favor the quick-adapting and anthropophilic mosquito species that transmit malaria. The report warns that these changes are impacting the “health, security, and livelihoods of people around the world,” particularly in the hardest hit African region. 

But climate change is threatening malaria control in other parts of the world, like Pakistan. The devastating floods that submerged a third of the country in 2022 also left pools of standing water – “ideal breeding grounds for mosquitoes” and leading to an 8-fold increase in malaria cases between 2021 and 2023, the report notes.

Cases rose from about half a million to more than four million. The increasing frequency of extreme weather events is expected to increase the burden of malaria in the long term, especially because the mosquitoes that transmit malaria are “highly sensitive” to environmental changes, noted Dr Arnaud Le Menach, Unit Head, Strategic Information for Response, WHO Global Malaria Progamme. 

Conflict and ensuing humanitarian crises are impeding efforts to curb malaria. “In some countries, their conflict is also stopping people from getting the needed health access and the needed commodities,” said Charles. Internally displaced peoples often lack access to malaria prevention and treatment, leaving them “highly vulnerable to the disease,” said Le Menach. The report highlights these additional drivers of malaria transmission, noting that more than 80 million people in malaria-affected countries are internally displaced or refugees in 2023.

Biological threats in the form of resistant mosquitoes and antimicrobial resistance make it increasingly difficult to control vectors and treat patients. Resistance to pyrethroids, a common insecticide, was reported in nearly every country it was monitored, while resistance to artemisinin, the most effective malaria treatment, was reported in four African countries. 

Better global, regional, and country coordination is a key solution, according to Charles, to bring together stakeholders. This includes involving civil society organizations and resource optimization to overcome the above challenges. 

Reaching vulnerable populations

The global report features for the first time highlights the significant disparities in malaria burden, with a particular emphasis on gender equality.

“[W]e need to keep in mind the issue of poverty, poverty being a significant risk factor,” said Alia El-Yassir, director of the WHO Department for Gender Equality. “Malaria takes the heaviest toll on those who are poorest and are the most disenfranchised segments of a society. The data shows that children under the age of five who are living in low income households have the highest prevalence of malaria, and as their socioeconomic status improves, the risk of malaria and the prevalence will decrease.”

A host of biological, environmental, social, structural, and economic factors converge to increase a person’s vulnerability to malaria, “disproportionately” impacting those living in poverty, refugees, migrants, and indigenous peoples, notes the report.

“Poverty is very much gendered…gender norms become so deeply entrenched and institutionalized that they will place many women and girls at a disadvantage, and that affects their risk of malaria and also their access to treatment,” said El-Yassir. To address these challenges, the report urges health system strengthening to collect disaggregated data because current averages “are not giving us the true picture in terms of who is being affected.”

Calls for funding ahead of replenishment rounds

Several panelists made calls for funding at a recent WHO press conference in Geneva given the current “shortfalls” in funding. In 2023, less than half of the target $8.3 billion was invested in malaria response. This gap has widened in the past several years from $2.6 billion in 2019 to $4.3 billion in 2023. The vast majority of these funds come from international sources, with endemic countries contributing 33% in the past decade.

“Next year is a very, very big year for all of us in the malaria world,” noted Dr Charles. “We have two replenishments. We have the GAVI replenishment, and we also have the Global Fund replenishment…The mosquito is so unrelentless and so smart that the longer we wait, the harder it is.”

Even with malaria vaccines available, GAVI, the Global Fund, and the President’s Malaria Initiative all need replenishment “to realize the promise of the vaccine and other interventions,” argued Dr Hamel.

The Global Fund also released a statement urging funding to meet targets, making the argument that “investing more in the fight to end malaria not only has the potential to save millions of lives, but it can also help rebalance global economic power and stimulate trade.

“This, in turn, can unlock additional funding to strengthen health systems and enhance health security both in Africa and around the world. Malaria investment is not just a health imperative—it is a strategic driver of broader, far-reaching economic and social benefits,” said Peter Sands, Global Fund executive director, in a press release.

Image Credits: Fanjan Combrink / WHO.

Africa CDC Director-General Dr Jean Kaseya (centre) during a visit to the DRC last week.

There is still no clarity about the cause of the mystery disease affecting people in the Panzi district of Kwango province in south-west Democratic Republic of Congo (DRC), despite hopes that it would be diagnosed by the past weekend.

Getting laboratory test results is proving more challenging than previously hoped as the district’s “limited laboratory capacity means that samples have to be transported to the national reference laboratory in [the capital of] Kinshasa”, according to the Africa Centres for Disease Control and Prevention (Africa CDC).

But the 700 km journey to Kinshasa currently takes about 48 hours due to poor roads and the rainy season, according to the World Health Organization (WHO).

The communication network is also limited in Panzi, a rural community of around 200,000 people spread over more than 7,000 square kilometres.

Suspected diseases

By last Thursday, 406 cases and 31 deaths of the undiagnosed disease had been recorded (case fatality ratio of 7.6%). However, the reported cases peaked in epidemiological week 45 (week ending 9 November 2024), according to the WHO. It took almost six weeks for Panzi health officials to notify national health officials about the unusual rise in cases.

All severe cases were malnourished, according to the WHO’s Disease Outbreak News (DON) from Sunday.

“The clinical presentation of patients includes symptoms such as fever (96.5%), cough (87.9%), fatigue (60.9%) and a running nose (57.8%),” according to the WHO.

Almost two-thirds of cases (64.3%) are children under the age of 15 , and over half of the children’s cases involve kids under the age of five. Some 71% of deaths occurred in children under 15.

“The area experienced deterioration in food insecurity in recent months, has low vaccination coverage and very limited access to diagnostics and quality case management,” according to the WHO.

In addition, the area is experiencing a shortage of supplies and health workers, with limited malaria control measures and access to transport.

Given the context of Panzi and patients’ symptoms, the WHO has listed the main diseases that are suspected. These include measles, influenza, acute pneumonia (respiratory tract infection), hemolytic uremic syndrome from E. coli, COVID-19 and malaria. 

Both the WHO and Africa CDC have sent health experts to assist the DRC’s team to assess the situation, accelerate diagnostic testing, and implement control measures.

The multidisciplinary team includes epidemiologists, laboratory scientists, infection prevention and control experts.

Since the mpox outbreak, the Africa CDC has been working closely with the DRC’s Ministry of Health (MoH), the National Institute of Biomedical Research (INRB), the National Public Health Institute (NPHI) to strengthen disease monitoring through genomic surveillance. 

“This collaboration focusses on creating a sustainable national pathogen genomics strategy and decentralising laboratory capacity to improve outbreak response and preparedness,” according to Africa CDC.

INB co-chair Precious Matsoso (centre) ends the 12th meeting, flanked by co-chair Anne-Claire Amprou and Dr Tedros.

There will be no pandemic agreement by year-end and, with only 10 days of formal talks set aside in 2025, some parties doubt whether an agreement can be reached by the May 2025 deadline.

The week-long extended 12th meeting of the Intergovernmental Negotiating Body (INB) made progress, particularly on research and development (Article 9) and financing (Article 20). 

While disagreement remains on a couple of key obstacles, informal talks will continue alongside the formal talks.

Dr Tedros Adhanom Ghebreyesus, the World Health Organization’s (WHO) Director General, suggested at the close of the meeting on Friday evening that delegates consider negotiating on “packages” rather than clause by clause to “break the stalemate”.

“When I see what’s left, I believe – and this is honest from my heart – it is not really difficult to conclude in a few days of negotiation, but between now and the next meeting it would be good to think about the issues left and find a middle ground,” said Tedros.

Earlier in the day, INB co-chair Anne-Claire Amprou took exception to criticism of the process and lack of progress from some NGO observers.

Noting that the nature of multilateral negotiations means finding a “landing zone” that is acceptable to everyone, France’s Amprou said sharply: “I don’t agree when you say that nobody gains anything. I invite everyone – delegations, stakeholders – to look at what we have already achieved. We have achieved a lot.”

She stressed that the INB would deliver on its mandate: “We need a pandemic agreement which is meaningful, and it will be.”

‘Not a colouring book’

Amprou’s response came after Medicines Law and Policy commented that while there is some new “green text”, indicating agreement on the draft agreement, “it’s important to remember that the pandemic agreement is not a colouring book”. 

The European think-tank continued: “Substantive provisions on very difficult issues such as equity and access, transfer of technology, intellectual property and [pathogen] access and benefit-sharing remain largely absent, or are, at best, weak.”

Third World Network (TWN) followed, saying: “Every time we hear a new text is green, we are looking to figure out what has been compromised, especially in terms of equity.

TWN added that the agreement lacks “a baseline of legal rights and obligations”, and  “protects the interest of business, not people’s rights”.

Oxfam presented a list of questions and objections on behalf of 26 stakeholders including that member states appeared to be under “extreme pressure” to defer agreement on a pathogen access and benefit-sharing (PABS) scheme to an annex, the contents of which would be decided on after the pandemic agreement had been signed.

The Pandemic Action Network (PAN) and the Panel for Global Health Convention both urged negotiators to keep the momentum going and asked for clarity on the way forward.

Rafael Gracia of Pandemic Action Network and Dame Barbara Stocking representing he Panel for Global Health Convention

Eloise Todd, PAN’s executive director, told Health Policy Watch after the meeting that while the INB has not reached a conclusion, “there is a more urgent sense of progress around the negotiations which we need to encourage”.

Todd called on “high-income countries in particular to dig deep and remember the reason why we need this agreement is because of the deep-seated inequality in the COVID response”. 

“⁠⁠It is crucial for negotiators to see the bigger picture with these negotiations. The pandemic agreement will serves as an important marker the world’s coordination and cooperation in times of pandemic threats – which we know will become more and more frequent. It’s time to deliver on this vital step forward that will benefit people in every country,” said Todd.

However, Spark Street Advisors’  CEO and long-time talks observer Nina Schwalbe was less positive: “They have missed a once-in-a-generation opportunity to make a difference because national interests prevailed over global solidarity.”

Crux of the stalement

The stalemate centres on differences between the European Union (EU) and the Africa Group. The EU wants an annex linked to Article 4 (pandemic prevention) that outlines countries’ responsibilities to prevent pandemics. The Africa Group is reluctant to agree to costly responsibilities and it wants an annex related to the operationalising of a system for pathogen access and benefit-sharing (PABS) in exchange.

What the Africa Group wants from PABS is preferential access to any pandemic-related products that are developed from them sharing information about pathogens that could cause pandemics. This is anathema to the pharmaceutical industry, largely represented by the EU and the US.

The Africa group is also concerned that a prevention annex could impose costly requirements that they are unable to finance. However, the first beneficiaries of prevention measures are individual countries’ citizens who would be protected by, for example, heightened surveillance of bats that harbour Ebola and Marburg.

“These two areas are the make-or-break articles of the negotiations. If we can reach agreement on these, we will make the deal,” co-chair Precious Matsoso noted in an address to scientists recently.

Health leaders wanted an early agreement

Tedros has long urged delegates to reach agreement sooner rather than later and Dr Jean Kaseya, head of Africa CDC, has also expressed hope for an early agreement.

On a recent visit to South Africa, Matsoso noted: “We don’t have six months left to finish negotiations. We only have a couple of days left, precisely because the geopolitical environment is so challenging. There is huge, huge pressure on the talks and we don’t know what the outcome will be.”

The elephant in the room is the Donald Trump presidency, largely expected to take an axe to what Team Trump terms “globalism” – virtually anything that puts global good before national interest.

Delegates paid tribute to US Ambassador Pamela Hamamoto for her positive contribution to the pandemic agreement, as that was her last INB meeting.

Further INB meetings are scheduled for February and April, with a completed agreement supposed to be ready to be voted on at the World Health Assembly in May.

Mosquito and dengue
Mosquitoes, which can carry dengue virus, thrive at warmer temperatures. Climate change is already fueling increases in dengue cases globally.

Nearly one fifth of dengue cases in Latin America and the Caribbean, or about 45 million infections a year, are attributable to climate change, in the past decade, according to a new study by researchers at Harvard and Stanford Universities. 

Rising temperatures combined with mosquito species uniquely suited to sprawling urbanization and deforestation are fueling the staggering increase in dengue cases, with a proportion of cases measurably attributable to climate change, according to the first ever study to “meaningfully” quantify that number. 

Over the past year, both Latin America and the Caribbean saw a record-breaking number of cases – and fatalities – of the so-called “break-bone” fever. Even with the recent regulatory approval of two new vaccines, Takeda Pharma’s Qdenga® and Sanofi’s Dengvaxia, slow rollout and continued challenges in production scale-up have meant the jabs made little impact so far. 

The researchers compiled data from 21 countries in the Americas and in Asia to identify the causal effect of climate change-related temperature increases and dengue cases. The study was presented at the Annual Meeting of the American Society of Tropical Medicine and Hygiene (ASTMH) 13-17 November, and is available in pre-print form.

The researchers also estimated how different climate change scenarios will impact dengue burden. By 2050 under a high CO2 emissions scenario, the authors predicted  a 61% increase in dengue incidence. Active climate mitigation would cut that figure to roughly 40%. 

At least 257 million people now live in countries where warming temperatures could cause dengue to double by mid-century in either scenario. 

“We can see the direct policy implications of reducing emissions at the global scale,” Dr Kelsey Lyberger, an ecologist at Arizona State University and one of the study authors, told Health Policy Watch. The magnitude of dengue cases will not increase equally, either, Lyberger noted. “Some of the highest relative increases are in places where they don’t necessarily have a high burden currently.”

Dengue and climate change projections
Countries in cooler climates are projected to have the largest increase in climate change-related dengue cases.

But already now, increasing temperatures and extreme weather events are already changing the burden of infectious diseases – particularly vector-borne diseases. These temperature increases are already responsible for 45 million excess dengue cases, which the studied identified.  

The study, whose release coincided with the UN Climate Conference (COP29) in Baku, provides further evidence that climate action is “health action,” as termed in a recent WHO COP29 special report.

Cooler regions will see largest change

Dengue responds non-linearly to average daily temperature, with cases peaking at average temperatures of 28℃, and then decreasing. This creates “optimal” conditions for the two primary dengue mosquito vectors, Aedes aegypti and Aedes albopictus, where both species breed and feed faster. But in places where average temperatures are cooler – 15-20℃ on average – climate-change related warming has the largest effect on dengue caseload. 

As a result, projected warming will fuel dengue cases unequally across the globe. “It’s not across the board that we see this increase,” said Lyberger.  

Some cooler regions of Mexico, Peru, Bolivia, and Brazil, for instance, are predicted to see over 150% increases in dengue incidence due to climate change under any emission scenario, the study notes. 

Lack of surveillance data excludes Africa, India, Western Pacific from analysis

Dengue infographic
WHO’s Western Pacific region was among those excluded from the study due to a lack of reliable surveillance data.

While dengue cases continue to rise globally, including in much of the African continent, the lack of high quality surveillance systems means experts are left to guess the impact of climate change on dengue in these regions. 

Countries in the America, Brazil in particular, have felt the burden of dengue cases most acutely, but they often have surveillance methods in place to track infection rate fluctuations.

“We needed a long enough time series of cases to estimate a baseline level of dengue,” said Lyberger. Many African countries face surveillance hurdles in detection, reporting and management, the lack of local laboratory capacity, and the misclassification of cases, noted researchers at Africa CDC. Without a solid surveillance system, countries are at a critical disadvantage–including little early warning systems for dengue surges.

In India, the country’s “poor” surveillance network leads to “huge” under-reporting and a lack of public health response to outbreaks, as a Lancet editorial comments in India’s 2015 dengue season. A 2020 assessment of the country’s surveillance efforts found that dengue surveillance needs to be strengthened, and integrated into existing government initiatives. In that time frame alone, from 2015-2019, cases in the South Asian region increased by 46% according to WHO estimates. The organization attributes climate change, in addition to “high rates of population growth, inadequate water supply and poor waste management systems” coupled with the absence of effective treatment and suitable vector control to the high burden of dengue in the region. 

Preparing for the future

With these new estimates of how climate change will increase dengue cases, researchers hope that such high-burden countries will be motivated to do more tracking and reporting, while those that historically have had few cases can prepare with funding for surveillance and integrated vector management. 

“Since we’ve established this relationship between temperature and cases, the next step is to see how warming, both in the past and in the future, is going to affect the number of cases that we have or will see,” explained Lyberger.

This led researchers to compile data from 21 countries where dengue is endemic – including Brazil, Cambodia, Colombia, and Vietnam – and to examine other factors that could affect dengue infection rates like rainfall, seasonal changes, viral strains, economic shocks, and population density, to isolate the distinct effect of temperature. 

“We were able to pin down that historical warming has already increased dengue cases by about 20%,” said Lyberger. 

“It’s evidence that climate change already has become a significant threat to human health and, for dengue in particular, our data suggests the impact could get much worse,” said Erin Mordecai, PhD, an infectious disease ecologist at Stanford’s Woods Institute for the Environment and the study’s senior author in a press release. 

See Health Policy Watch’s ongoing coverage of dengue here.

Image Credits: Marissa L. Childs, Kelsey Lyberger, Mallory Harris, Marshall Burke, Erin A. Mordecai, WHO.

DRC Director-General of Health, Dr Dieudonné Mwamba.

The Democratic Republic of Congo (DRC) expects to diagnose ‘Disease X’, which has killed at least 79 people in the Panzi district of Kwango Province by the weekend, according to the country’s Director-General of Health, Dr Dieudonné Mwamba.

“The disease is characterised by fever, headaches, cough and sometimes difficulty breathing,” Mwamba told a media briefing hosted by Africa’s Centre for Disease Control and Prevention on Thursday. 

So far, around 376 people have been infected and the disease appears to be airborne, he added. Females are slightly more affected than males, and the majority of cases (52%) are under the age of 5. The second biggest group of patients is people aged over 25 (almost 30%).

“Given that we do not have a specific diagnosis, we don’t know whether we are faced with a viral or bacterial disease, but we believe that, in under 48 hours, the results of the laboratories will help us,” he said.

However, he noted that people in the impoverished rural Panzi district were “vulnerable” as there is a malnutrition rate of almost 40%, it recently experienced a serious typhoid outbreak. The DRC is also experiencing a seasonal influenza outbreak.

Panzi does not have the capacity to test the specimens taken from patients with the unknown disease, so they have been sent to a laboratory in Kikwit some 500km away.

The first case of the unknown illness was identified on 24 October in the largely rural south-eastern province bordering Angola. However, central authorities were only notified of a possible outbreak on 1 December, according to Dr Jean Kaseya, Africa CDC Director-General, who addressed the briefing from the DRC.

“We want to reinforce the surveillance. We have a delay of almost five to six weeks, and in [that time], so many things can happen. This is why we are supporting the country to build strong capacity for surveillance,” said Kaseya.

A team from Africa CDC, including an epidemiologist and laboratory and infection prevention control (IPC) experts, is being sent to Panzi on Friday to assist officials, he added.

Mpox continues to spread

Meanwhile, Mpox continues to spread, particularly in Central Africa, with 2,700 new cases in the past week, up from 2,618 new cases the previous week,  said Kaseya.

The outbreak has affected 20 African countries. After laboratory testing, Zambia and Zimbabwe have confirmed that their outbreaks are Clade 1b.

“In total, we have 62,171 cases. Last week, we lost 36 people, and that brings a total of 1200 deaths since January 2024,” said Kaseya.

However, only 13, 579 of the cases have been clinically confirmed as laboratory testing remains a challenge in many areas.

The DRC remains the worst affected by mpox, with both clade 1a and 1b circulating. The lion’s share of the week’s new cases – 2,115 – were identified in the DRC and all 36 of the week’s deaths were in the DRC.

However, testing remains a challenge in the country, with only 20% of cases confirmed by laboratories.

Africa CDC also flagged the links between high burdens of mpox cases and measles cases in DRC, but has not yet established a causal link between the two diseases.

 

Sudanese women, many of whom became leaders of the 2019 revolution, are being targeted by soldiers using rape as a weapon of war.

Rape is common across Africa yet inadequate laws, weak implementation and cultural barriers mean that many perpetrators go unpunished, according to new research by Equality Now.

“After examining rape laws across Africa, it is clear that to end impunity for perpetrators, governments urgently need to carry out comprehensive legal reform of rape laws, strengthen enforcement mechanisms, and improve access to justice and support for survivors,” said Jean Paul Murunga, a human rights lawyer and the report’s lead author. 

The report looked at rape laws and their enforcement in 47 African countries with an in-depth analysis of nine of these: Cameroon,  Democratic Republic of Congo, Madagascar, Rwanda, Senegal, Sierra Leone, South Africa, South Sudan, and Zambia.

Equality Now Africa Director Faiza Jama Mohamed says that the report identifies “key gaps in rape law that result in routine denial of justice to survivors of sexual violence”. 

“The gaps include laws allowing the perpetrator to walk free on reaching some form of ‘settlement’, including marrying the victim; laws framed in terms of morality rather than bodily integrity, thereby perpetuating a cycle of violence and discrimination; laws that explicitly permit rape in marriage, even of children,” notes Mohamed, writing in the foreword of the report.

Narrow definition of rape

Approximately 33% of women in Africa have experienced intimate partner violence or sexual violence in their lifetime, while in West, East, Central, and Southern Africa, the rate 44%, according to UN Women.

The African Development Bank’s Gender Data Index 2019 reported that intimate partner sexual or physical violence ranges from 10% to 40% across the continen

“It is critical for its definitions in the various jurisdictions within Africa, both in the context of conflict and peace, to be clear and based on human rights standards,” adds the report.

Rape is when a person has not given voluntary, genuine, and willing consent for sexual interaction – and that this consent can be withdrawn anytime during the interaction.

“True consent is impossible in situations of dependency or extreme vulnerability, for example, in educational settings, correctional facilities, or when a victim is incapacitated, such as being intoxicated or infirm,” according to the report.

Several countries’ definitions of rape or legal frameworks fail to recognise all forms of unwanted sexual penetration (anal, oral, or vaginal by use of any body part or object) as rape .

Some 25 African countries have penal codes that are “incomplete or ambiguous and do not meet international standards” by, for example, confining the definition to acts of violence and failing to recognise rape involving intimidation, coercion, fraud, and unequal power dynamics. 

Marital rape not recognised

Justice for rape survivors

Cote D’Ivoire, Gambia, Seychelles, Equatorial Guinea, Ethiopia and South Sudan do not criminalise marital rape. South Sudan explicitly notes that non-consensual sexual intercourse within marriage does not constitute rape. 

The Penal Code of Côte d’Ivoire provides for the presumption of married couples’ consent to the sexual act unless proven otherwise. 

Eritrea only criminalize marital rape when spouses are not living together, while Tanzania criminalizes it if the couple is not living together. Lesotho recognises marital rape under certain conditions.

In Gabon, where child marriage is legal, if an abductor has married an abducted minor, he can only be prosecuted after the marriage is annulled.

“International human rights standards require states to criminalise all forms of rape, irrespective of the relationship between the perpetrator and their victim,” says Murunga. 

“Failing to specifically criminalise marital rape ignores how consent must be ongoing and freely given, regardless of marital status. Legal recognition provides clarity to law enforcement, prosecutors, and judges that marital rape must be treated as a serious crime and prosecuted accordingly.”

Harmful traditional beliefs

Although 20 African countries have consent-based definitions of rape, rapists are often shielded by traditional beliefs and societal attitudes towards sex. 

“Rape survivors and their families frequently face stigma, victim-blaming, and threats. This is commonly accompanied by pressure to remain silent, withdraw criminal complaints, and settle cases out-of-court through informal community mediation,” according to the report.

In Equatorial Guinea, for example, out-of-court settlements are legally permitted when a rape victim explicitly or tacitly forgives the perpetrator. 

This often results in rape survivors being pressurised to agree to this route.

In several countries, officials opt not to investigate, prosecute, or convict rape cases unless there is physical evidence, especially which indicates a victim fought back. 

“Many jurisdictions emphasize force, morality, or circumstances and apply gender-discriminatory concepts such as ‘honour’ and ‘modesty’. This prejudices judgments over victims’ behavior and “chastity” and whether they are perceived as deserving justice for having been raped,” the report notes.

Rape survivors and their families frequently face stigma, victim-blaming, and threats. This is commonly accompanied by pressure to remain silent, withdraw criminal complaints, and settle cases out-of-court through informal community mediation. 

Inadequate punishment

Sudanese women wait for treatment at Fashir Reproductive health centre. Many women are pregnant as a result of being raped during the conflict.

The African Commission on Human and People’s Rights recommends 16 years imprisonment for rape, but many countries have thresholds well below this. 

In Equatorial Guinea, Article 429 of the Criminal Code states that “rape of a woman shall be punished with minor confinement.

Guinea Bissau includes an exemption where ‘the behavior of the victim has considerably contributed” to the rape.

Even where not elaborated in the law, settlements with respect to rape are reportedly common in Benin, Cameroon, Chad, Côte d’Ivoire, The Gambia, Ghana, Guinea, Liberia, Nigeria and South Sudan.

In South Africa, there is a serious backlog of rape cases and insufficient funding for the justice delivery system. In May 2022, the Minister of Justice announced that only 19% of reported cases were going through the courts.

With the breakdown of the rule of law and security in conflicts, women and girls are rmore vulerable. In addition, rape is still being used as “a weapon of war to denigrate, disempower, demoralize and destroy communities”, the report notes. 

During conflict, reporting cases, collecting evidence and prosecution are often huge challenges.

Providing justice to survivors of sexual violence and ensuring perpetrators do not enjoy impunity is critical in preventing and addressing rape

With so many legal, procedural, and societal obstacles to addressing rape, very few cases make it to court, and even fewer result in conviction.

Urgent reform 

Urgent reform is needed to ensure legal definitions of rape encompass all acts of non-consensual sexual penetration, with no exceptions for marital rape, according to the report.

It also calls for adequate training of government officials to ensure laws are implemented and other measures including a register of sex offenders. 

“Effective legal implementation is equally crucial, requiring robust mechanisms to enforce justice and hold perpetrators accountable. Transparency and accountability are essential to building trust and ensuring fairness in how cases are handled,” the report notes.

It advocates for supportive systems for rape survivors that” facilitate healing and enable them to pursue justice if they choose”

Rwanda is highlighted as a positive example for promoting a “victim-centered approach to investigating and prosecuting sexual violence cases” that includes .gender-based violence recovery centers in numerous districts, providing survivors with witness protection, medical and psychosocial support, and legal aid.

Image Credits: CC, Mohamed Zakaria/ UNICEF.

Ambassador John Nkengasong, head of PEPFAR.

As a political appointee, Ambassador John Nkengasong, head of the US President’s Emergency Plan for AIDS Relief (PEPFAR), said that he will be obliged to resign when President-elect Donald Trump is inaugurated on 20 January.

“The rules that govern a transition are that all the political appointees have to resign on the 20th and then their resignation is either accepted or they are asked to stay,” Nkengasong told a Global Fund media briefing on Monday.

However, he stressed that PEPFAR has been a bipartisan programme since its inception in 2003 when it was launched by Republican President George W Bush.

“It has since enjoyed the support of all administrations,” said Nkengasong, the US Global AIDS Coordinator in the Bureau of Health Security and Diplomacy.

Nkengasong was appointed by President Joe Biden, confirmed by the US Senate in May 2022, and he started work the following month. 

PEPFAR achievements 2024
PEPFAR’s achievements by 2024.

Nkengasong is a Cameronian-born US citizen, who first attracted global attention as the first head of the Africa Centres for Disease Control and Prevention (Africa CDC), where he led the continent’s response to the COVID-19 pandemic. Prior to that, he had worked for the US Centers for Disease Control and Prevention, as well as at the World Health Organization. 

“We should always think about PEPFAR, not the individual – 26 million lives saved over the last 21 years,” Nkengasong stressed at the briefing, although his re-appointment prospects are regarded as slim.

“PEPFAR was reauthorised [by the US Congress] for one year last year. That reauthorisation expires in March, and we are hoping that we’ll get a clean five-year reauthorisation going forward,” he added.

But this may not be plain sailing. PEPFAR has come under attack from US and African conservatives who claim – incorrectly – that some aid recipients are promoting abortion. This is why the programme only received a one-year extension rather than the usual five years.

Trump has made cutting government spending and opposing abortion cornerstones of his election campaign, which does not augur well for the campaign to end AIDS by 2030.

HIV money is drying up

HIV is incurable but thanks to antiretroviral (ARV) drugs, it has become a controllable chronic disease and if people living with the virus have an undetectable viral load, they don’t transmit HIV.

As many as 25 million people depend on PEPFAR and the Global Fund to subsidise their ARVs, which they need to take for life. 

Yet money is drying up. About 60% of the HIV response is paid by domestic finances, and this fell for the fourth consecutive year, with a 6% drop in 2023. Meanwhile, donor resources for HIV dropped by 5%, UNAIDS Deputy Director Christine Stegling told the briefing.

UNAIDS deputy director Christine Stegling.

Global Fund executive director Peter Sands said that global overseas development assistance is under pressure, and health has lost its “prime spot” to both climate change and conflict.

“There is a particular issue with funding for HIV/ AIDS, which is that we run the risk of being a victim of our own success. Because the number of people dying has dropped so much, and because HIV/ AIDS is no longer seen as that much of a threat in donor nations themselves, it’s dropped off the radar screen and seems like an old problem; one that’s largely won or gone away,” said Sands.

“But HIV is a formidable adversary. We are nowhere near getting a vaccine, and we don’t have a cure for it yet.”

But the single-minded focus on eliminating HIV has made “extraordinary progress”, Sands added.

“AIDS-related deaths have come down by 51% since 2010 and more than three-quarters of people living with HIV are on treatment, but we still have another nine million people not on treatment and we still have 1.3 million new infections each year,” according to Stegling.

Shift to domestic financing

Economist Professor Dean Jamison, co-chair of the Lancet Commission on investing in health, says it is unlikely that for a better response to funding HIV globally. 

“So that does put greater emphasis on a transition to domestic finance where the reliance has been substantially on donors. It’s not to say that the external finance is likely to go away and then there won’t be important additions to that. I would be looking to parts of Asia for external finance, but on the domestic side, what are the range of options?” asked Jamison, who is an emeritus professor of Global Health Financing at UCSF, UCLA and the University of Washington.

Poor countries would prioritise HIV spending, likely focusing on preventive interventions and treatment. Drawing on private resources, perhaps through payroll taxes, may also be a solution.

Professor Dean Jamison

Stegling singled out debt, low economic growth and insufficient revenue as the main obstacles to domestic financing for HIV.

“Last year in GDP term, Sierra Leone spent 15 times more on public debt servicing than on health. Chad spent 12 times more on debt servicing than on health,” she noted.

Meanwhile, sub-Saharan Africa loses about $80 billion in uncollected tax revenue.

Debt relief, future financing at affordable rates and better tax revenue collection are the solutions UNAIDS is focusing on.

“These are the issues of the future that we need to look into if we’re talking about self reliance, more resilient systems for health that are financed by countries, by every country themselves,” Stegling noted.

With South Africa being the chair of the G20 next year, she sees “an amazing opportunity” for African leadership debt restructuring and different financing mechanisms. 

What lies ahead?

Stegling says donors are likely to move into “gaps”, such as human rights protections for particular marginalized groups that might not immediately find support from their governments.

Meanwhile, Nkengasong stressed that progress should not be confused with success.

“The progress that we have made is very fragile,” Nkengasong stressed.

PEPFAR did an analysis of 10 to 12 high-burden countries that it supports and found that, to maintain their programmes if PEPFAR was unable to fund them would result in debt risk increasing by 400 percentage point,.

“Are we ready to live with this? We pride ourselves with the success we’ve made over the last 25 years or so against HIV. But the response to HIV is extremely fragile. It’s extremely fragile because it requires that the millions of people that are receiving treatment receive that treatment every day.

“We cannot afford to leave them behind. If we do that, the billions that we’ve put into the fight against HIV AIDS will be completely wasted.”

Image Credits: US State Department.

A policy panel held at the World Vaccine Congress Europe.

From being a largely unknown pathogen, Respiratory Syncytial Virus (RSV) is now almost a household word – and a fearful one for families with infants and young children at risk. But new solutions, such as long-acting monoclonal antibodies (mAbs) and maternal vaccination, both recently recommended by the World Health Organization (WHO), could dramatically alter the RSV landscape.  

Scientific experts and health policy advocates explored these new preventative tools for RSV and their initial uptake in  Italy and Spain at a recent panel discussion at the recent European World Vaccines Congress.

Lower respiratory tract infections (LRTI) are the leading cause of death, and hospitalisation for infants globally. The global incidence of RSV-associated LRTI is estimated at over 30 million cases in children under the age of five, resulting in 3.2 million hospitalisations.

The impact of RSV in high-income and upper-middle-income countries is best documented insofar as it is associated with high hospitalisation rates and significant healthcare costs. But the impact may be even more severe in low and middle-income countries, but less well-recognized. 

“Almost three-quarters of the deaths associated with severe respiratory diseases in infants occur outside hospitals because of issues of access to care,” said Professor Heather Zar, head of the Department of Paediatrics and Child Health and director of the Unit on Child and Adolescent Health at the University of Cape Town in South Africa.

Impact on families

Hospitalisations for respiratory diseases, particularly RSV, place a considerable financial and emotional burden on families, with stress that extends beyond the child. 

According to a survey conducted by the National Coalition for Infant Health in the US, close to 68% of parents said watching their child suffer from RSV impacted their mental health. More than one-third said the experience strained their relationship with their partner.

The survey also found that many parents had to make difficult sacrifices, with 10% quitting their jobs to care for their child and 7% even being fired for taking time off. These hardships underscore the importance of preventive measures to lessen the multifaceted impacts on families.

Long-term burden of respiratory illnesses

Respiratory illnesses can have lasting consequences on a child’s health. Zar shared insights from research that connects early-life RSV with chronic respiratory issues such as asthma and recurrent lung infections: “Children who experience early RSV infections are more likely to suffer from recurrent pneumonia, and face a significantly higher risk of asthma later in life.”

This chronic burden reinforces the necessity of early intervention.

RSV hospitalisations are longer than those for respiratory viruses such as influenza and rhinovirus, exacerbating the strain on healthcare systems.

The ReSViNET Foundation, an international non-profit organisation that works towards reducing the burden of RSV, observed in its studies that parents often went to their GP multiple times before RSV was recognised, sometimes resulting in a dangerous escalation to the point where the child needed to be taken to hospital by  ambulance. 

New tools to prevent RSV 

With recent advances in preventive care, experts believe that tools such as long-acting monoclonal antibodies (mAbs) and maternal vaccination could dramatically alter the RSV landscape. 

The WHO’s Strategic Advisory Group of Experts (SAGE) has recommended that all countries introduce maternal vaccination and/ or long-acting mAbs for RSV prevention in young infants. 

“Long-acting monoclonal antibodies and maternal vaccines provide passive immunity and last through the RSV season, protecting infants during the most vulnerable period of life,” said Zar.

Spain’s recent RSV immunisation campaign offers a glimpse into the potential effectiveness of these new tools. Professor Federico Martinón-Torres reported that Galicia’s RSV mAbs campaign achieved over 90% uptake in high-risk and newborn cohorts, with an 82% reduction in hospitalisations for severe RSV.

This success showcases the efficacy of long-acting mAbs. It underscores the potential of universal immunisation programmes to mitigate the seasonal burden of infant RSV, reducing the toll on infants and their families.

Italy is now taking steps to introduce RSV mAbs for infant immunisation this season, said Professor Elena Bozzola, national counsellor of the Italian Paediatric Society (SIP).  “Since the national health service fully subsidises the immunisation of children in Italy, it is a great opportunity to protect all infants with RSV mAbs,” she added. 

Challenges in implementing technologies

Barriers persist in ensuring that scientific advances reach all infants. Disparities in access, cultural misconceptions about vaccine safety, and inconsistent national guidelines pose significant roadblocks to the widespread adoption of new tools for RSV prevention. 

For instance, in the US many hospitals do not administer RSV immunisations to newborns due to reimbursement complications. Hospitals receive a bundled payment for each birth, and modifying this to cover RSV immunisations can take years of negotiation with insurers.

Spain’s programme, while effective, also encountered obstacles: “We didn’t know how the population or healthcare providers would accept this. However, following a robust awareness campaign, the results were remarkable,” said Martinón-Torres.

The path to universal access remains challenging, especially in regions with weaker healthcare infrastructure and limited funding.

Pivotal moment

The emerging tools for RSV prevention represent a pivotal moment in infant health. Their successful implementation will lay the groundwork for future prevention of other diseases using mAbs and could be a model for introducing other new technologies. “The coming years will be exciting to see as more countries explore these technologies for wider adoption,” Zar said.  

Today, effective prevention strategies for RSV can reduce infant mortality and alleviate the broader societal and economic impacts on families, healthcare systems, and communities, the experts in our meeting agreed. 

Our health systems and policies must evolve alongside these innovations. For instance, our thinking needs to extend beyond traditional delivery methods and create additional access points for administration. 

The journey to wider access requires continued advocacy, funding, and collaborative efforts. With a concerted approach from healthcare professionals, policymakers, and society, we can make a major stride in infant health.

This article is based on the discussions of a policy panel held at the World Vaccine Congress Europe, and sponsored by MSD.

Susan Hepworth is executive director of the  National Coalition for Infant Health.

Leyla Kragten-Tabatabaie is on the board of directors of ReSViNET Foundation

A new report cautions that land degradation, if not reversed in time, could harm generations.

The world needs to urgently change the way food is grown and land is used in order to avoid irreparable harm to global food production capacity, according to a major new scientific report released Sunday.

Currently seven out of nine ‘planetary boundaries’ have been negatively impacted by unsustainable land use, mostly related to unsustainable agriculture, warns the report produced by the German-based Potsdam Institute for Climate Impact Research (PIK) along with  the UN Convention to Combat Desertification (UNCCD).

Approximately 15 million km² of land area, or 10% of the world’s terrestrial space, is already severely degraded, as measured by the extent of deforestation, diminished food production capacity, and the disappearance of freshwater resources. And this degraded land area is expanding each year by about 1 million km², according to the report.

“We stand at a precipice and must decide whether to step back and take transformative action, or continue on a path of irreversible environmental change,” said Johan Rockström, Director at PIK who is also the lead author of the report.

There are conflicting figures on the extent of global land degradation, due to differences in definitions and indicators according to a paper by Jiang et al (2024).

Shifting food production to “regenerative agriculture” practices as well as land restoration to improve the health of lakes, rivers and underground aquifers are among the immediate solutions needed to make a course correction.

Without rapid adoption of such measures, the Earth’s capacity to support human life and wellbeing could be irretrievably harmed, the report warns. This harm can be in the form of the collapse of the Arctic ice sheets and the weakening of the land’s ability to act as a carbon sink.

Failure to reverse land degradation trends that result in deforestation and impoverished soils will also have long-term, knock-on impacts with respect to hunger, migration, and conflict, the report warns.

“If we fail to acknowledge the pivotal role of land and take appropriate action, the consequences will ripple through every aspect of life and extend well into the future, intensifying difficulties for future generations,” said Ibrahim Thiaw, Executive Secretary of the UNCCD.

Land is under threat from human activities, climate change

The concept of planetary boundaries is anchored in nine critical thresholds essential for maintaining Earth’s stability. Rockström was the lead author of the study that introduced the concept of planetary boundaries in 2009.

How humanity uses or abuses land directly impacts seven of these planetary boundaries, which include: climate change, species loss and ecosystem viability, freshwater systems, and the circulation of naturally occurring nitrogen and phosphorus, the report said. Land use changes, such as deforestation, also broach a planetary boundary.

“The aim of the planetary boundaries framework is to provide a measure for achieving human wellbeing within Earth’s ecological limits,” said Johan Rockström, lead author of the report.

Currently, the only boundary that is within its “safe operating space” is the stratospheric ozone as that was addressed through a 1989 treaty called the Montreal Protocol that sought to reduce ozone-depleting chemicals in the atmosphere. This also is an example of how taking action can have a positive long-term impact.

Along with unsustainable agricultural practices and the conversion of natural ecosystems to monocultures of cultivation, deforestation and urbanisation all are putting these planetary limits under pressure. Agriculture alone accounts for 23% of the greenhouse gas emissions, 80% deforestation and 70% freshwater use.

In addition, challenges such as climate change and biodiversity loss are worsening land degradation creating a vicious cycle, according to the report.

What governments must do

The report urges the use of ‘regenerative agriculture’ that focuses on improving soil health, carbon sequestration and biodiversity enhancement.

Agroecology that emphasizes holistic land management, including the integration of forestry, crops and livestock management, is another solution.

In addition, woodland regeneration, no-till farming that causes less disturbance to soil, improved grazing, water conservation, efficient irrigation and the use of organic fertilisers, are some of the other solutions that have been highlighted.

For water conservation the report urges reforestation, floodplain restoration, forest conservation and recharging aquifers, along with improving the delivery of chemical fertilizers – the majority of which currently runs off into freshwater bodies.

Transformative actions can halt land degradation

Numerous multilateral agreements on land-system change exist but have largely failed to deliver. The Glasgow Declaration to halt deforestation and land degradation by 2030 for instance was signed by 145 countries at the Glasgow climate summit in 2021, but deforestation has increased since then.

Keeping forest cover above 75% keeps the planet within safe bounds for instance, but forest cover has already been reduced to only 60% of its original area, according to the most recent update of the planetary boundaries framework by Katherine Richardson and colleagues.

Authors of the report added that the principles of fairness and justice are key when designing and implementing transformative actions to stop land degradation so that the benefits and burdens are equitably distributed.

They also said that action must be supported by an enabling environment, substantial investments, and a closer collaboration between science and policy.

This report was launched ahead of the UNCCD summit that is being called COP16 this year, and is taking place in Riyadh, Saudi Arabia. Following a disappointing COP29 in Baku, there is concern that actions are falling short in the face of climate crisis.

Image Credits: Unsplash, UNCCD report.