Few countries are effectively taxing tobacco, alcohol, sugary drinks and ultraprocessed food, in part due to massive industry pushback.

Governments have weakened their commitment to addressing non-communicable diseases (NCDs) after pressure from “big tobacco, alcohol, junk food, and fossil fuels”, according to civil society.

Their claim centres on the draft political declaration due to be adopted at the UN High-Level Meeting (HLM) on NCDs in September, which no longer calls on countries to implement high taxes on these unhealthy products.

Countries are due to wrap up negotiations on the declaration this week, with the final declaration due to be adopted at the HLM on 25 September. 

“It looks like health-harming industry fingerprints are all over this,” said Alison Cox, director of policy and advocacy at the NCD Alliance. 

“At a time of fiscal pressures, shrinking global health funding, and increased emphasis on domestic resource mobilisation, health taxes are a golden opportunity to both generate revenue and reduce the burden of NCDs and associated healthcare costs,” she added.

“Yet as it stands, the declaration’s text contains weaker language around taxes and lets industry off the hook, prioritising profits over public health,” added Cox, describing the draft as “a backslide”.

The language in the current draft has been watered down, and targets have been “flattened”, with active commitments to ‘implement’ and ‘enact’ replaced with the “far more passive language of ‘consider’ and ‘encourage’,” according to the NCD Alliance.

‘Reinstate commitment to taxes’

Vital Strategies, a global public health organisation, urged the negotiators to “reinstate explicit commitment to health taxes” on tobacco, alcohol and sugar-sweetened beverages. 

“These taxes should increase prices sufficiently to reduce affordability, prevent initiation and support reduction or cessation of use,” said Vital Strategies in a media release.

“As outlined by the Task Force for Fiscal Policy on Health, a 50% price increase on tobacco, alcohol, and sugary beverages could raise $2.1 trillion in five years for low- and middle-income countries, revenue equal to 40% of their total health spending,” added the organisation.

NCDs, including heart disease, cancer and diabetes, account for 43 million deaths annually, 75% of all deaths worldwide. The burden of NCDs is growing in low- and middle-income countries, driven primarily by smoking and poor diets.

Taxes on alcohol, restricting marketing and regulating sales hours are proven interventions to reduce consumption.

Vital Strategies also raised alarm about the removal of references to the World Health Organization’s (WHO) “Best Buy” policy recommendations for reducing alcohol consumption and related diseases, including raising taxes, restricting marketing and regulating availability. 

“The conspicuous deletion of these proven policies from the text strongly suggests undue alcohol industry influence aimed at weakening public health protections. We urge governments to immediately reverse these deletions and fully restore WHO’s recommendations in the final text,” said Vital Strategies.

Harmful commercial practices

It also wants the declaration to “explicitly tackle harmful commercial practices and strengthen conflict-of-interest protections to safeguard public health policymaking from industry interference”, strengthen commitments to “proven tobacco control measures” including effective taxation, and “recognise unhealthy diets as an urgent priority”.

The WHO attributes some 2.8 million deaths a year to obesity and overweight, and Vital wants the declaration to “explicitly state that rising obesity rates are primarily driven by unhealthy diets, emphasising clear interventions like front-of-pack labelling and marketing restrictions targeting children”.

The NCD Alliance is also unhappy about “significant backsliding” around social participation and the role of civil society, which is only referred to once. 

“History has taught us that ignoring the integral role of civil society, communities and people living with diseases weakens any meaningful public health response,” said Cox.  

With just a week of negotiations remaining, the NCD Alliance is calling on governments to “demonstrate true leadership and resist last-minute compromises that prioritise commercial interests over public health and reflect a genuine commitment to protecting lives”.

Image Credits: Leo Zhuang/ Unsplash, Stanislav Ivanitskiy/ Unsplash.

Cigarette filters, made from a plastic called cellulose acetate, are world’s most littered plastic item.

As negotiators prepare to meet in Geneva, 5-14 August in yet another attempt to finalize the United Nations Global Plastics Treaty addressing a pollution crisis affecting oceans and ecosystems worldwide – a critical linkage between health and environment governance seems to be largely missing from the draft text.

After nearly three years of negotiations, the world may be on the verge of finalizing its first legally-binding global instrument to tackle plastic pollution – providing that treaty negotiators overcome massive pressures from the fossil fuel industry to further stall an agreement or weaken provisions aiming to limit plastics production.  

But as negotiators prepare for the resumed fifth session (INC-5.2),  another fundamental flaw threatens the future treaty’s health objectives: the failure to integrate environmental and health governance. 

This is particularly apparent with regards to cigarette filters – the world’s most littered plastic item – although it extends to cross-sector cooperation on other issues regarding the health harms of other plastics as well.

The current draft text makes with only one reference to ‘plastic’ cigarette filters (in draft Annex X) and makes no reference at all to the WHO Framework Convention on Tobacco Control – which could, in fact, be an important nexus for health-environment cooperation on the treaty – once it is approved.

The treatment of cigarette filters – largely made of a plastic called cellulose acetate – sends smoke signals about more systematic problems with the treaty text in terms of its approach to environment and health.

Health rhetoric vs reality gap

Cigarette filters are the world’s most prevalent forms of plastic litter, marring beaches and from there, infiltrating to oceans and fresh water ways.

The Chair’s text, the working document guiding final negotiations, acknowledges health extensively in its rhetoric, although much of it remains in brackets, indicating areas where countries have not yet reached agreement.

The preamble recognizes plastic pollution as “a serious environmental and human health problem,” while the treaty’s stated objective is “to protect human health and the environment from plastic pollution.”

But while the preamble recognizes mutual support with “other international agreements in the field of the environment,” it limits that framework to environmental treaties. 

Any reference to health instruments, including the WHO Framework Convention on Tobacco Control (FCTC), which has been ratified by 183 countries, are absent from this structure. 

Draft Plastics Treaty negotiating text – much of language on health remains in brackets.

The Chair’s preambular text affirms that the plastics treaty will “not affect… existing treaty obligations,” but this is a non-binding statement that merely avoids direct legal contradictions without promoting substantive policy coherence. 

In practice, it enables siloed implementation, weakens the ability of health ministries to regulate tobacco product components, and gives the tobacco industry new opportunities to exploit regulatory gaps through the environment ministries.

Most tellingly, a standalone health article remains uncertain, reduced to scattered references or a placeholder “pending informal drafting work.” Despite the draft’s stated health objectives, the institutional bridge to health governance is still missing. 

The ‘safe alternatives’ problem 

This gap matters because “safe substitutes,” “safe alternatives,” or “safe recycling” are at the heart of solutions throughout the draft treaty. But how can environmental authorities evaluate safety and health impacts without connecting to international or national health standards?

The tobacco industry is already exploiting this governance gap by promoting “eco-filters” and “biodegradable” alternatives to plastic cigarette filters. While these products may appear to address plastic pollution, they remain harmful to both health and the environment. 

Worse, they risk misleading consumers and this kind of product feature substitution is typically assessed by health authorities, not environmental ministries, which may lack the mandate or expertise to evaluate such claims.

The cigarette filter test case

Cigarette filters are the most littered plastic in the world.

Used cigarette filters represent the world’s most littered plastic item, with trillions discarded annually. Each cigarette butt contains toxic lead, cadmium, phthalates, and polycyclic aromatic hydrocarbons that leach into waterways. A single cigarette butt can contaminate 1,000 liters of water, causing $26 billion in annual marine ecosystem damage.

The FCTC provides clear guidance on these filters: Parties should prohibit ingredients in tobacco products that may create the impression that they have a health benefit. 

The WHO study group’s recommendations early this year included that filters should be banned to reduce the palatability and appeal of cigarettes. This would remove consumer misconceptions that filters reduce health harms, and it would also reduce a major source of toxic tobacco waste, including the microplastics deposited by cellulose acetate in filters. 

Annex X: plastics items recommended for limitations, but not ban or phaseout.
Annex Y: proposed ban or phaseout list.

Yet the draft plastics treaty only lists “cigarette filters made with plastic” in a priority list for mandatory or voluntary restriction or banning (Annex X), rather than on the ban or phaseout list (Annex Y).  The “made with plastic” language for cigarette filters also creates a dangerous loophole that permits biofilters/ eco-filters, contradicting established health guidance.

In contrast, Annex Y, the ban/ phase out list, itemizes toys and food containers containing lead, cadmium, and phthalates – the same toxicants found in cigarette filters. 

Broader governance architecture problem

The cigarette filter case reveals systemic weaknesses in the treaty draft’s language around health. Article 2.2 of the FCTC requires Parties to ensure that subsequent international agreements should be compatible with FCTC obligations. However, the negotiating states have yet to provide a mechanism for ensuring this compatibility. When environmental ministries approve product redesigns without health authority input, both agendas suffer. When industries exploit policy gaps to rehabilitate their image while maintaining harmful products, both environmental integrity and health objectives are compromised.

Extended Producer Responsibility schemes promoted throughout the draft treaty could also legitimize tobacco industry participation in environmental policy and its greenwashing, directly contradicting FCTC Article 5.3’s requirement to “protect tobacco-related environment policies” from industry interference.

The problem extends far beyond tobacco. Plastic substitution decisions made in isolation from health expertise risk creating new health hazards while solving environmental concerns—essentially trading one set of risks for another. Environmental authorities may inadvertently approve alternatives that address plastic pollution while creating health risks.

Infrastructure already exists

Plastics health impacts in brief.

The solution isn’t to build new health systems from scratch, as many countries already have relevant capacity, and global infrastructure exists, including for chemical safety, food standards, and medical devices. 

For tobacco, global networks like TobLabNet and TobReg provide evidence-based guidance. 

The real challenge is not global coordination, but national-level inter-agency cooperation. The future plastics treaty can help by explicitly obligating this, ensuring health and environment agencies work together. 

Without giving due regard to existing health treaties, such coordination will inevitably run up against the different standards these agencies follow on industry engagement. No credible health authority engages with the tobacco industry, which is prohibited globally under the WHO’s Framework of Engagement with Non-State Actors (FENSA) and nationally through Article 5.3 of the FCTC, which covers over 90% of the world’s population.

The commitment to binding norms on conflict of interest in the FCTC is essential. It creates space for the broader safeguards called for by civil society, scientists, and the Office of the High Commissioner for Human Rights (OHCHR). 

Failing to respect existing obligations—especially in the clearest and extreme case of tobacco— effectively precludes any meaningful prevention of conflicts of interest.

Integration not isolation

The solution lies in strengthening the draft’s health foundation by explicitly recognizing existing health agreements, including the WHO’s FCTC, which was already referenced in previous drafts to promote “cooperation, coordination, and complementarity.”

A global coalition focusing on this issue recommends a simple safeguard clause – “Measures taken under this instrument shall be without prejudice to, and aligned with, existing international public health treaties and obligations, (including the WHO FCTC)” – would help prevent regulatory conflicts while provide supportive infrastructures to bolster the authority of environmental ministries to implement the future treaty.  

For cigarette filters, the recommendation is to eliminate material qualifiers “made of plastic” and move filters to a list for immediate bans. 

More broadly, the future instrument needs formal mechanisms for health expertise integration—not transferring authority from the environment to health ministries, but creating coordination mechanisms ensuring both objectives are met.

The Geneva opportunity

The Global Plastics Treaty could model integrated governance for 21st-century planetary health challenges, or represent another missed opportunity for coherent global health governance.

Tobacco control shows how weak coordination between health and environmental sectors can backfire. 

When environmental agencies promote so-called “eco-filters” without health input, they risk legitimizing harmful products. 

But the reverse is also true. During COVID-19, health-led responses drove a surge in plastic consumption, worsening pollution. Both cases expose the same flaw: without coordination, one sector’s solution can become another’s crisis.

The Plastics Treaty offers a rare chance to correct this. The infrastructure exists. The evidence is clear. 

What’s missing is the political will to connect them through binding legal frameworks. Geneva may be the last, best opportunity, not only to curb plastic pollution, but to safeguard the future of global health governance. 

Integrating international health agreements into the treaty does more than align with existing obligations. It helps define the treaty’s direction and lays the foundation for a strong, legally binding instrument with robust regulatory measures and comprehensive protections for people and the planet.

Deborah Sy is head of Strategy and Global Public Policy at the Global Center for Good Governance in Tobacco Control (GGTC) at Thammasat University in Thailand, the convener of Global Youth Voices and the Stop Tobacco Pollution Alliance (STPA). She is the founder and senior advisor of Health Justice Philippines, an observer to the UN Plastics Treaty negotiations.

Image Credits: Dennis Skley, University of Bath , UNEP , Chairs Text, draft UN Plastics Treaty, December 2024, Chairs Text, UN Plastics Treaty, Draft 2024, Ciel.org.

A woman with HIV takes her antiretrovial (ARV) medicine. Until earlier this year, over 20 million people with HIV received ARVs funded by PEPFAR.

US State Department officials are developing a plan to transform the President’s Emergency Plan for AIDS Relief (PEPFAR) from an entity that tackles HIV to one that is broadly focused on protecting and promoting American interests.

This is according to a report in the New York Times on Thursday, based on leaked planning documents that map out their vision for PEPFAR’s transition in in the next few years.

“It would be replaced by ‘bilateral relationships’ with low-income countries focused on the detection of outbreaks that could threaten the United States and the creation of new markets for American drugs and technologies,” the newspaper reports.

This is in keeping with the focus of the Trump administration’s first meeting with African health leaders after the US paused all foreign aid for 90 days in January.

During the meeting between leaders of the US Centers for Disease Control and Prevention (CDC) and their counterparts in Africa CDC in March, the US officials indicated that they were interested in African business opportunities for American companies.

Africa CDC official Dr Ngashi Ngongo told journalists after the meeting that the Trump administration “would like to see health more as a business, rather than something that functions on grants,” and is interested in “exploring how can we go into a partnership that translates into health as a business”.

Aggressive transition planning

Dr Jirair Ratevosian, a global health expert at Duke and previous PEPFAR chief of staff, said that the Trump administration has “made it very clear that they want to carry on with aggressive transition planning” for PEPFAR.

“Transition planning is not a bad idea, but it must be done right, with timetables, developing indicators, matching government buy-in, getting community input etc,” Ratevosian said.

While he has not seen the documents referred to by the New York Times, Ratevosian is concerned that the transition plan is being written in Washington rather than in and with the African countries most affected by  PEPFAR’s transition.

“There needs to be realistic timetables, careful planning and resources to successfully make the transition of HIV programming [from PEPFAR] to national control,” said Ratevosian. 

“Congress has made clear it rejects the administration’s rushed approach to PEPFAR’s transition, signalling bipartisan concern about protecting the program’s legacy and impact.”

He added that the US State Department should also develop plans for US companies to sell their antiretroviral drugs to African countries, the largest market for these products.

Brief defunding reprieve

Luyengo Clinic in Eswatini. PEPFAR funded 80% of the clinic’s cost, and the HIV treatment of 3,000 people is in jeopardy.

Last week, there was a brief moment of hope for PEPFAR recipients after the US Senate  agreed to exempt the programme from a planned $400 million reduction, which had been included in a $9.4 billion rescission package put forward by President Donald Trump.

The rescission package seeks to claw back federal funds from various programs, including approximately $900 million in global health allocations.

Disruptions to US aid for global health including for PEPFAR programmes, have placed millions of lives at risk, particularly in countries heavily dependent on US-supported HIV infrastructure.

Carolyn Amole, Clinton Health Access Initiative vice-president for HIV, hepatitis and TB, said PEPFAR’s funding cuts had disrupted commodities procurement, essential systems such as human resources, supply chains, and data infrastructure.

Millions more AIDS deaths, infections projected

An additional six million new HIV infections and four million AIDS-related deaths could occur between 2025 and 2029 if US-supported HIV treatment and prevention services collapse, according to UNAIDS.

“This is not just a funding gap. It’s a ticking time bomb,” said UNAIDS Executive Director Winnie Byanyima at the launch of the organisation’s 2025 global AIDS update earlier this month.

“We have seen services vanish overnight. Health workers have been sent home. And people – especially children and key populations – are being pushed out of care.”

“Key populations” refer to people most vulnerable to HIV infection, including sex workers, men to have sex with men, people who inject drugs and young women.

Some of the immediate effects of the US withdrawal of funds since Donald Trump assumed the presidency in January include the closure of health facilities, healthworker job losses, and disrupted treatment, testing and prevention services.

Image Credits: The Global Fund/ Saiba Sehmi, UNAIDS.

Six-month-old Salam is screened for malnutrition at an UNRWA medical point in Gaza City.

“There is mass starvation in Gaza,” World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyesus asserted on Wednesday, aligning with a statement by 110 aid organisations released earlier that day.

“A large proportion of the population of Gaza is starving. I don’t know what you would call it other than mass starvation, and it’s man-made,” Tedros told a media briefing on Wednesday, referring to aid blockage since the controversial private organisation, the Gaza Humanitarian Foundation (GHF) assumed control over aid distribution.

“Rates of acute malnutrition exceed 10%, and over 20% of pregnant and breastfeeding women that have been screened are malnourished, often severely,” said Tedros.

“The hunger crisis is being accelerated by the collapse of aid pipelines and restrictions on access [with] 95% of households in Gaza facing severe water shortages.”

In their statement, the aid organisations including Medecins sans Frontieres (MSF), CARE, Christian Aid, Save the Children and Oxfam, urged governments to ensure that Israel ends “the siege of Gaza” and allows “the full flow of food, clean water, medical supplies, shelter items, and fuel through a principled, UN-led mechanism”.

For the past two months, aid has not been channelled through UN agencies but rather via the GHF, which is supported by the governments of Israel and the United States.

Since the GHF assumed control over aid distribution on 27 May, over 1,000 people have been killed by Israeli forces while trying to get food at the GHF distribution centres, according to the United Nations human rights office on Tuesday.

“Doctors report record rates of acute malnutrition, especially among children and older people,” according to the aid organisations. 

“Illnesses like acute watery diarrhoea are spreading, markets are empty, waste is piling up, and adults are collapsing on the streets from hunger and dehydration. Distributions in Gaza average just 28 trucks a day, far from enough for over two million people, many of whom have gone weeks without assistance.”

‘Tip of the iceberg’

Dr Tedros Adhanom Ghebreyesus addresses a media briefing on Wednesday.

“I don’t know why we’re even splitting hairs,” said Tedros, in reference to debate about whether Gazans were starving. “Not only were 1,026 people killed while trying to feed themselves or find food for their family, but thousands were also wounded.”

“We demand that there is full access [for humanitarian aid], and we demand that there is a ceasefire. We demand that there is a political solution to this problem, a lasting solution. And we also demand the release of the hostages, as we have always said,” Tedros concluded.

On Monday, the UN World Food Programme (WFP) said that a quarter of Gaza’s population faces famine-like conditions.

Dr Rik Peeperkorn, WHO representative for Palestine, said that malnutrition in Gaza had been negligible before Israel attacked Gaza in retaliation for Hamas’s attack on Israel on 7 October 2023. The malnutrition rate in children under the age of five was 0.6% then, while it did not exist in pregnant women or the elderly.

But this year, around 30,000 children are reported to be malnourished and 21 have died of hunger, said Peeperkorn, describing these statistics as “the tip of the iceberg”.

“In July alone, 5,100 children have been admitted to the malnutrition programme, including 880 children with severe malnutrition,” said Peeperkorn.

Several hospitals in the territory do not have the staff or supplies to function and have become malnutrition treatment centres, but two months ago, they lacked nutritional supplements for patients, he said.

Iman, six months old, is screened for malnutrition at an UNRWA medical point in Gaza city (July 2025)

Aid staff also face starvation.

Peeperkorn added that UN staff members were facing the same conditions of lack of water and food, and there was widespread “absolute lethargy” in Gaza as people lacked the energy to do basic tasks.

The aid organisations similarly reported that their staff are hungry and don’t have access to clean water.

 “Aid workers are now joining the same food lines, risking being shot just to feed their families. With supplies now totally depleted, humanitarian organisations are witnessing their own colleagues and partners waste away before their eyes,” they said.

“Doctors, nurses, journalists, humanitarians, among them UNRWA staff, are hungry… fainting due to hunger and exhaustion while performing their duties,” Juliette Touma, director of communications for the UN agency for Palestine refugees (UNRWA), said in a media statement on Tuesday.

Touma described “the so-called GHF distribution scheme” as  “a sadistic death-trap”, adding that “snipers open fire randomly on crowds as if they’re given a license to kill”.

She also told of massive food prices, recounting that a colleague paid almost $200 for a bag of lentils and some flour, after walking for hours to buy it.

The GHF claimed on Monday that, “Since launching operations on May 27, we’ve distributed nearly 85 million meals via more than 1.4 million boxes—directly to the people of Gaza”.

However, Israeli media outlet Haaretz said that GHF should have distributed several times this amount to ensure sufficient food.

“If roughly 2.1 million people live in the Gaza Strip today, it’s preferable for them to eat three meals a day, and GHF had been in operation for 56 days as of Monday, how many meals should it have distributed? A simple calculation produces the answer – 353 million,” reported the news outlet.

The GHF has also been criticised for distributing dry food when people are unable to cook, setting up too few food distribution centres and locating them in isolated areas, forcing thousands of people to walk long distances while exposed to IDF attacks and stampedes.

Over 90% of Gaza is under Israeli evacuation orders, and nowhere is safe for residents.

Earlier this week, the GHF offered to distribute the UN’s aid but the UN responded on Wednesday, saying that it would not work with any groups that put civilians’ lives in danger.

WHO staff detention and warehouse destruction

WHO warehouse in Deir al Balah lies in ruins after it it was attacked by Israeli military forces on Sunday and Monday.

Meanwhile, one WHO staff member remains in Israeli detention following an Israeli Defence Force attack on the WHO’s staff residence and its biggest warehouse in Deir al Balah.

Declining to name the staff member, Tedros said he had written to Israel’s Foreign Minister to demand his release and would take this up “at the highest level” if he remained in custody.

The IDF attack on the warehouse caused severe damage, destroying “a substantial amount of medical supplies in all areas: trauma, antibiotics and anaesthesia”, said Peeperkorn.

However, while this was a setback for the global organisation, it had identified other potential premises and would continue to support health facilities in Gaza, he added.

“We demand that there is full access, and we demand that there is a ceasefire. We demand that there is a political solution to this problem, a lasting solution. And we also demand the release of the hostages,” said Tedros.

Tougher EU stance against Israel?

The European Union (EU) seems to be toughening its stance against Israel in the face of the growing outcry over the starvation of the population.

On Tuesday, the EU High Representative for Foreign Affairs and Security Policy Kaja Kallas posted on X that “all options remain on the table if Israel doesn’t deliver on its pledges” to increase the number of aid trucks, crossing points and routes to distribution points.

“The killing of civilians seeking aid in Gaza is indefensible. I spoke again with [Israeli Minister of Foreign Affairs Gideon Saar] to recall our understanding on aid flow and made clear that IDF must stop killing people at distribution points,” said Kallas.

EU Commission President Ursula von der Leyen also posted on X on Tuesday, declaring that “Civilians cannot be targets. Never. The images from Gaza are unbearable.”

Von der Leyen added: “The EU reiterates its call for the free, safe and swift flow of humanitarian aid. And for the full respect of international and humanitarian law. Civilians in Gaza have suffered too much, for too long. It must stop now. Israel must deliver on its pledges.”

Image Credits: UNRWA.

The International Court of Justice (ICJ) headquarters in The Hague, The Netherlands

The International Court of Justice (ICJ) ruled on Wednesday that states have a duty to prevent significant harm to the environment from climate change in a landmark advisory opinion.

The court also ruled that the states have a duty to cooperate internationally and called on them to set national climate targets that are of the “highest possible ambition.”

“The court concludes that the duty of states to prevent significant environmental harm applies in the context of climate change, and that this duty forms part of the most directly relevant applicable law concerning the duty to cooperate,” said ICJ President Judge Yuji Iwasawa, who read out the advisory.

The court addressed the issue of human rights and said they cannot be enjoyed without environmental protection. It has asked countries to bear in mind the Paris Agreement target to limit global warming to 1.5° C.

The ICJ’s ruling comes in response to a United Nations (UN) General Assembly resolution led by the small island nation of Vanuatu in the Pacific Ocean, which sought ICJ’s advisory opinion on the obligations of states on climate change, and the legal consequences of these.

This is the first opinion on climate change by the ICJ, and it is seen as a landmark in international law as all UN members are automatic signatories of the ICJ.

The ICJ, UN’s principal judicial organ of the UN, has a twofold role: to settle disputes between states and to give advisory opinions on legal questions. 

Climate crisis is a health crisis

WHO Director-General Tedros Adhanom Ghebreyesus speaking at the ICJ in December 2024.

While the ICJ did not explicitly refer to health, Iwasawa made it clear that countries have to ensure that their Nationally Determined Contributions (NDCs) or the climate targets they set for themselves are ambitious.

“This means that each party has to do its utmost to ensure that the NDCs it puts forward represent its highest possible ambition,” Iwasawa said. While few countries have included health targets in their NDCs, there is an increasing global push to do so.

The ICJ took the testimonials of a range of stakeholders into account in the run-up to the verdict. In 2024, World Health Organization’s Director-General Dr Tedros Adhanom Ghebreyesus spoke at the ICJ giving his testimonial on how the climate crisis is a health crisis.

In his testimonial, Tedros highlighted how climate change’s health impacts disproportionately affect small island nations like Tuvalu, also in the Pacific Ocean.

“Climate change and extreme weather are wreaking havoc on humans and their health, disrupting societies, economies and development,” Tedros said.

“Without immediate action, climate-related increases in disease prevalence, destruction of health infrastructure and growing societal burdens could overwhelm already overburdened health systems around the world,” he added.

ICJ opens the door for reparations

ICJ President Judge Yuji Iwasawa, Japan, delivering the advisory opinion

Iwasawa, while acknowledging that the effect of climate change is “severe and far-reaching,” noted that the ICJ was not asked to rule specifically on the issue of compensation or climate damages.

“The court considers that it has been requested to address legal consequences in a general manner, and that it is not called upon to identify the legal responsibility of any particular state or group of states,” he said.

He added that any such request must be looked at on a case by case basis. “Concerning the duty to make reparation, the appropriate nature and quantum of reparations cannot be assessed in the abstract, and depends on the circumstances of a particular case,” he said.

Reparations could take the form of ecological restoration or reconstruction of damaged infrastructure, the ICJ suggested.

Climate-related drought in the Horn of Africa has impacted approximately 4.5 million Somalis, and around 700,000 individuals have been forced to leave their homes.

“From deadly heat and toxic air to disease and displacement, the Court’s message is clear – human health is not collateral damage,” said Dr Jeni Miller, executive director at the Global Climate and Health Alliance.

“Health workers and advocates now have powerful legal backing to demand bold, science-based climate action rooted in justice, including a just transition away from fossil fuels, for health and the duty to protect life across all ages and borders,” she added.

Harjeet Singh, climate activist and founding director of Satat Sampada Climate Foundation, described the ruling as offering the potential for “a historic level of protection” for communities on the frontlines of climate change.

“It means the suffering, the loss of homes and livelihoods, and the terrifying storms and rising seas that have become our reality can now be met with demands for justice, restitution, and repair. The message is clear: the polluters must pay,” said Singh.

The ICJ advisory comes at a time when the US government is planning to repeal the scientific finding that established greenhouse gases endanger human life by pushing up global temperatures. This finding, established in 2009, gives governments the ability to push for climate action.

However, the Trump administration is on its way to repeal the finding, which now means the US will be at odds with ICJ’s latest advisory.

“Cooperation between states is the very foundation of meaningful international efforts with respect to climate change,” Iwasawa said.

Image Credits: ICJ, Photo by ICJ/CIJ | Frank van Beek, UN Photo/ICJ-CIJ/Frank van Beek. Courtesy of the ICJ., UN-Water/Twitter .

Billionaire entrepreneur and philanthropist Michael Bloomberg.

United States (US) Health and Human Services (HHS) Secretary Robert F Kennedy Jr should promote public confidence in vaccines or be fired, according to Mike Bloomberg, the former mayor of New York, who has been the World Health Organization’s (WHO) Global Ambassador for Noncommunicable Diseases (NCDs) and Injuries since 2018. 

“Kennedy, who has no training in medicine or health, has long been the nation’s foremost peddler of junk science and the crackpot conspiracy theories that flow from it,” wrote Bloomberg in a hard-hitting opinion piece published in Bloomberg News on Tuesday.

“The greatest danger in elevating him to HHS secretary was always that he would use his position to undermine public confidence in vaccines, which would lead to needless suffering and even death. And so it has come to pass,” said Bloomberg, in one of the hardest-hitting critiques of Kennedy’s six-month term from a global health leader.

“Before this year, no one in the US had died from measles in a decade. This year, three people have died, two of them children. Yet Kennedy downplayed the outbreak, saying it was ‘not unusual’, “ Bloomberg said, blasting Kennedy’s failure to use his position to urge parents to vaccinate their children against measles.

“Some 1,300 cases of measles have now been reported this year, with children accounting for two-thirds of them. More than 160 people have been hospitalized — and survival does not guarantee a full recovery. Measles can lead to pneumonia and worse, including brain swelling and permanent disability.”

The latest report from the US Centers for Disease Control and Prevention (CDC) records  1,319 measles cases in 40 states, with 92% of these in people who are either unvaccinated or whose vaccination status is unknown. Children under the age of five make up the biggest group of people hospitalised as a result of measles.

US measles cases from January 2023 to 15 July 2025

Bloomberg said that other infectious diseases could also make a comeback under Kennedy, who has fired scientists, cut research and “fired all 17 members of the CDC’s vaccine advisory panel, which recommends the vaccines Americans should get.”

New advisory council members appointed by Kennedy include  “a variety of people without significant expertise in immunology, including those in the anti-vaccine movement — which promises to make the unfolding disaster even worse”.

Bloomberg, who initially ran for mayor of New York City as a Republican in 2001, reserved particular criticism for the Republican Senators, including medical doctor Bill Cassidy, who confirmed Kennedy as HHS Secretary.

Republican Senators need to ‘constrain Kennedy’s deadly actions’

Cassidy’s own question during Kennedy’s confirmation hearing provides the clear summary of the current situation, added Bloomberg.

Cassidy asked: “Does a 70-year-old man who has spent decades criticizing vaccines, and who’s financially vested in finding fault with vaccines — can he change his attitudes and approach now that he’ll have the most important position influencing vaccine policy in the United States?”

“The answer was always obvious,” said Bloomberg. “Kennedy never gave any indication that he would be changing his stripes, but Cassidy and his colleagues deceived themselves into thinking otherwise — or, worse, they knew better and simply buckled to political pressure, placing their own political careers above the lives of their constituents.”

“Senate Republicans have made this mess, and they need to clean it up,” said Bloomberg. “They have a constitutional responsibility to conduct oversight of Kennedy, and they have a moral responsibility to do everything possible to constrain Kennedy’s deadly actions — or force him out.

“That should include demanding that the White House pressure Kennedy to start promoting faith in vaccines, including by appointing more qualified people to the vaccine panel — or fire him.”

He concluded that “making America healthy again starts with bringing Kennedy to heel — or sending him packing”.

“Until Senate Republicans summon the courage to do that, more Americans will get severely sick and die — and Republicans will suffer the backlash at the polls.”

Bloomberg has poured millions of dollars of his considerable fortune into funding philanthropic efforts to combat tobacco use, eradicate polio, and address obesity, road safety, maternal health, and drowning. 

The Aedes mosquito, which transmits chikungunya virus.

A large outbreak of the mosquito-borne virus, chikungunya, is spreading rapidly from three Indian Ocean islands to Africa, while parts of South East Asia are also experiencing outbreaks, warned the World Health Organization (WHO) on Tuesday.

Around two-thirds of the population of the French island of Réunion has been infected with chikungunya over the past year, with other large outbreaks on the islands of Mayotte and Mauritius, Dr Diana Rojas Alvarez, WHO lead on arboviruses, told a Geneva media briefing on Tuesday.

She warned that a large global outbreak 20 years ago affecting about half a million people also started in the Indian Ocean islands, and urged health authorities to be on alert.

“Just like 20 years ago, the virus is now spreading further to other countries such as Madagascar, Somalia and Kenya, and there has been an epidemic transmission also occurring in South East Asia – in India, Sri Lanka, Bangladesh and more,” she added.

Since the beginning of the year, Reunion has confirmed 54,410 cases of chikungunya, with 2,860 visits to the emergency room, 578 hospitalisations and 28 deaths, according to a report issued by the Pacific Community (SPC) on Tuesday.

Recent cases have been reported in France and Italy in people with no history of travel to the islands, and diagnosis in Europe may be slow, as doctors have little experience with the tropical disease.

Dr Diana Rojas Alvarez, WHO lead on arboviruses

The virus is transmitted by Aedes mosquitoes, and people infected with the virus can also transmit it back to mosquitoes that bite them, which enables the virus to spread rapidly.

The virus was first detected in the Americas (St Martin island) in 2013, and within a year, had affected over a million people in the region.

“The symptoms of Chikungunya are mostly acute, with very high fever, severe joint pain, muscle pain, skin rash and severe fatigue,” said Alvarez.

“The joint pain usually lasts for a few days, but up to 40% of the people who are infected with chikungunya can develop long-term disabilities that can last for a few months or even years,” she warned.

Since first being identified in Tanzania in the 1950s, chikungunya has been detected in 119 countries, and about 5.6 billion people live in areas at risk for the virus, said Alvarez.

 

Chikungunya causes rashes and acute joint pain.

Urgent action to prevent spread

““It is still not too late to prevent further transmission and the spread of the virus,” said Alvarez.  “We are calling for urgent action to prevent history from repeating itself. There is no particular treatment for chikungunya, so people need to avoid mosquito bites.”

Key preventive measures include the use of insect repellent, wearing long-sleeved clothing and trousers, installing screens on windows and doors and removing standing water from containers like buckets, tyres and flower pots that are mosquito breeding grounds, she explained.

Two chikungunya vaccines have received regulatory approvals in several countries, but have not yet been recommended for global use as there is not enough information about their efficacy yet.

However, the WHO and external expert advisors are reviewing vaccine trial and post-marketing data in the context of global chikungunya epidemiology to inform possible recommendations for use.

The WHO’s Strategic Advisory Group of Experts (SAGE) on immunisations will meet in the next few weeks to advise the global body on the vaccines, said Alvarez.

“WHO is currently supporting member states by deploying and strengthening laboratory diagnosis, risk communication and community engagement, training clinical workers and strengthening surveillance and mosquito control,” said Alvarez.

Image Credits: PAHO.

The Working Group on amending the IHR during a meeting last December.

The United States’ decision last Friday to reject amendments to the International Health Regulations (IHR) – aimed at improving the global response to disease outbreaks – is based on “inaccuracies”, according to the Director General of the World Health Organisation (WHO).

“We regret the US decision to reject the amendments adopted by consensus by the World Health Assembly in 2024 – including by the US, as the US played an active role in developing and negotiating those amendments together with other countries,” said Dr Tedros Adhanom Ghebreyesus.

Member states “have the right to decide whether or not to adopt and, subsequently, implement amendments to the IHR”, added Tedros.

US Health Secretary Robert F Kennedy Jr and US Secretary of State Marco Rubio claimed in a statement that the amendments “significantly expand” the WHO’s “authority over international public health responses” and will “have undue influence on our domestic health responses”.

This criticism of the IHR Amendments is part of the narrative of Project2025, the Trump administration’s governing blueprint published by conservative think-tank the Heritage Foundation before the 2024 US elections.

Learnings from COVID-19

In response, Tedros said he wished to “correct inaccuracies stated by Secretary Kennedy and Secretary Rubio”.

Tedros noted that the 2024 amendments “were proposed, negotiated and adopted by member states, based on the learnings from the COVID-19 pandemic” and “are not about empowering WHO, but about improving cooperation among member states in the next pandemic.

In addition, said Tedros, the “amendments are clear about member states’ sovereignty” and that the WHO “has never had the power to mandate lockdowns, travel restrictions or other such measures”, but “member states have the power to do so if they see the need”. 

The US officials also claimed that the amendments “create additional authorities for the WHO for shaping pandemic declarations, and promote WHO’s ability to facilitate “equitable access” of health commodities”, and “fail to adequately address the WHO’s susceptibility to the political influence and censorship – most notably from China – during outbreaks”.

However, Tedros said that “risk communication is an essential part of any emergency response, as populations need to be informed in a timely way”. 

“Using disease outbreaks for propaganda would be destructive and disastrous,” stressed Tedros, adding that the WHO “is impartial and works with all countries to improve people’s health”.

Georgetown University’s Professor Lawrence Gostin, who assisted the WHO to draft the IHR, said that Kennedy’s claim that amendments “ open the door to the kind of narrative management, propaganda, and censorship that we saw during the COVID pandemic” was untrue.

“The IHR facilitates rapid detection and response. It actually promotes accurate information and protects civil liberties. And it certainly does not affect US sovereignty. These are all falsehoods,” said Gostin, who is the O’Neill Chair in Global Health Law at Georgetown University.

What are the IHR amendments?

The IHR were amended after the SARS outbreak in 2005, but widespread criticism of the WHO’s slow response to COVID-19 prompted member states to resolve to amend the regulations again to enable speedier and more sophisticated responses to health emergencies.

The new amendments to the IHR include the introduction of the definition of a “pandemic emergency” to trigger more effective international collaboration in response to events that are at risk of becoming a pandemic. 

There is also a new commitment to solidarity and equity, based on strengthening all countries’ access to medical products and financing. This includes establishing a “Coordinating Financial Mechanism” to help raise funds to enhance developing countries’ pandemic emergency prevention, preparedness and response-related capacities.

While the IHR proposes the establishment of a “States Parties Committee” to facilitate the implementation of the amended regulations, this is “non-punitive” and based on supporting and facilitating inter-country cooperation rather than dictating how countries should respond to disease outbreaks.

The US was a vice-chair of the Working Group on Amendments to the IHR (WGIHR) that negotiated to amendments to the IHR under the Biden administration, and the US delegation stressed that they would not accept an agreement that undermined US sovereignty.

“The experience of epidemics and pandemics, from Ebola and Zika to COVID-19 and mpox, showed us where we needed better public health surveillance, response and preparedness mechanisms around the world,” said Dr Ashley Bloomfield of New Zealand, WGIHR co-chair , at the conclusion of the negotiations on the amendments.

His co-chair, Dr Abdullah Assiri of Saudi Arabia, added that the amendments  “strengthen mechanisms for our collective protections and preparedness against outbreak and pandemic emergency risks”.

Image Credits: WHO.

Transitioning to cleaner cookstoves and fuels

Achieving universal access to clean cooking across Africa will require $37 billion in cumulative investment to 2040, or roughly $2 billion per year, according to the roadmap laid out by the International Energy Agency (IEA) in its latest report.

The roadmap envisions that 60% of the energy for the newly connected households will come from liquefied petroleum gas (LPG) and the rest from electricity, bioethanol, biogas and advanced biomass cookstoves. Urban areas would be able to reach near-complete access by 2035 while rural access would expand steadily through the 2030s, should countries receive necessary support from the international community.

“This new IEA report provides a clear, data-driven roadmap for every household across Africa to gain access,” said Fatih Birol, executive director, IEA.

“The problem is solvable with existing technologies, and it would cost less than 0.1% of total energy investment globally. But delivering on this will require stronger focus and coordinated action from governments, industry and development partners,” he added.

The IEA report also tracks the outcomes of the summit on clean cooking in Africa – held in May 2024 in Paris which mobilised over $2.2 billion in public and private sector commitments. More than $470 million of those commitments have already been disbursed, according to the report.

Meanwhile, in the broader energy picture, a new United Nations (UN) report found that there is great potential for expansion of renewable technology across the world but countries still need to move faster. “The clean energy future is no longer a promise. It’s a fact. No government, no industry, no special interest can stop it,” UN Secretary-General António Guterres said during the report’s release.

Guterres expressed confidence that transitioning to clean energy is only a matter of time, given that it makes more financial sense. Clean energy also tends to be safer and easier to access even in remote areas, he added.

Areas that need investment

Population without access to clean cooking by region, 2010-2023.

While access to clean cooking is improving in most parts of the world, including Asia and Latin America, it is the reverse in sub-Saharan Africa leading to more focus on the region within Africa.

At the moment, around four in five households in sub-Saharan Africa still cook with polluting fuels like wood, charcoal or dung, often over open fires or basic stoves. The population without access to clean cooking in this region stands at one billion.

While the United Nations’ Sustainable Development Goals (SDGs) aimed for universal access to clean energy by 2030, the world is currently off track to meet that goal.

Transitioning to clean cooking is helpful not just to meet that goal but it is also seen as a ‘low-hanging fruit’ when it comes to climate action is it also reduces carbon emissions.

Clean cooking access rates and annual improvements in sub-Saharan Africa by region.

IEA’s roadmap estimates that 80 million people can gain access to clean cooking fuel every year until 2040, which is sevenfold increase compared to today’s pace. To do this will require $37 billion in cumulative investment to 2040.

This investment would go towards upfront spending on household equipment such as stoves, fuel cylinders and canisters, as well building the enabling infrastructure like fuel distribution networks, storage terminals and electricity grid upgrades. This will also create an estimated 460,000 jobs by 2040, according to the report that made an investment case for clean cooking.

LPG will be 60% of the new connections, supported by other sources like solar and electricity. While electric cooking is the rage in developing countries and very efficient, the unreliable or non-existent nature of electricity in parts of the developing world make it unviable as a solution that can be deployed at scale. Solar too has its limitations when it comes to the changing weather that might reduce sunshine as well as the limited battery capacity to store the energy generated.

“Clean cooking is not a luxury. It’s an issue that touches every family, every day,” said Tanzania’s President Samia Suluhu Hassan. “The African Union (AU) Dar es Salaam Declaration on clean cooking, signed earlier this year by 30 heads of state from across Africa and now adopted by the AU Assembly in February this year, is a clear signal of our commitment to making energy access and clean cooking a national and continental priority,” she added.

Tracking progress of financial commitments

Hassan emphasized that countries will need support from partners to improve access to clean cooking. IEA’s report says that some of the support is on the way.

IEA has documented that $470 million of the pledged $2.2 billion in commitments in 2024 have already been disbursed. The pledged money is coming from both governments as well as the private sector. Nearly 18% of this money came from governments and 82% by private sector actors. Ireland and the United States are the two governments that have disbursed the entire sum they committed to.

Following the summit, 10 out of the 12 African governments that were a part of the clean cooking in Africa summit have enacted or implemented new clean cooking policies. Currently over 70% of people without access to clean cooking live in countries that strengthened their policy frameworks since 2024, according to IEA’s report.

Tanzania and Kenya demonstrated the largest increase in policy coverage since 2024. Ghana, Kenya, Nigeria, Malawi, Mozambique, Tanzania, Uganda, and Zimbabwe are the sub-Saharan Africa countries that have the widest coverage of key clean cooking policies, the report said.

The policies included government programmes that supported clean cooking fuels like LPG, tax incentives for switching to clean cooking and cooking stove distribution programmes, amongst others.

For nearly two thirds of sub-Saharan Africans affordability remains a major constraint as they would need to spend more than 10% of their income to adopt clean cooking solutions. To make clean cooking more affordable for the underserved population would require special attention by governments and policy focus.

Boost to women’s health, quality of life

An Indian woman cooks with an LPG stove that she received as a participant in the HAPIN study that looks at the impact of switching to LPG on health.

Indoor air pollution was linked to 3.2 million annual deaths in 2020, according to the World Health Organization (WHO). Most of those affected are women and children.

IEA’s report estimates that the number of pre-mature deaths for Africa is around 815,000, and that improving access to clean cooking will improve women’s lives tremendously. Women also spend up to four hours a day gathering fuel for cooking, including firewood. This time could have been otherwise spent in gainful economic activity or rest and leisure.

While clean cooking certainly saves times, at the moment the evidence on the health gains it would lead to is missing. Results of recent household trials where the family switched from biomass to LPG did not show significant health gains.

Where Africa stands at the moment

Investments in sub-Saharan Africa’s cooking infrastructure and equipment, 2019-2023.

IEA report finds that while access to clean cooking by 2040 is achievable across Africa, it will require efforts across governments, industry, civil society, and the international community.

Investments have continued to rise since 2013, but more is needed, especially in underserved areas.

“With strong political commitment, targeted finance and regional cooperation, we can make universal access to clean cooking a reality for every African household. The IEA’s leadership in convening partners and tracking progress has been instrumental in elevating clean cooking on the global agenda and turning pledges into real action on the ground,” said Lerato Mataboge, African Union Commissioner for Infrastructure and Energy.

Image Credits: Climate and Clean Air Coalition , IEA, India HAPIN team.

Canada’s struggle with substance use is more than a health issue—it’s a matter of language, policy, and public trust, said Dr. Kwame McKenzie in the latest episode of the Global Health Matters podcast with Dr. Garry Aslanyan.

McKenzie, CEO of the Wellesley Institute and Director of Health Equity at Canada’s Centre for Addiction and Mental Health, stressed that terms like “substance abuse” are outdated.

“People tend to talk about substance use, not abuse,” he explained. “It’s a useful term because it focusses on health rather than illness.”

Canada’s biggest problem isn’t illegal drugs—it’s alcohol.

“Heavy drinking is 16% of the population,” said McKenzie.

Illegal drugs? Just 3%. Yet the opioid crisis has been devastating.

“Before COVID, Canada averaged 11 daily deaths from opioid toxicity. By 2022, that number increased to more than 21,” he said, attributing the spike to a more toxic, unpredictable supply chain disrupted by the pandemic.

While some Canadian provinces moved toward decriminalisation, political headwinds have pushed back. “We have seen a return to non evidence-based political arguments, which are again trying to say that substance use is a moral failing,” he warned.

McKenzie contrasted Canada’s path with Portugal, where health—not criminality—is the focus.

“There’s lots of evidence to show that [Portugal’s model] increased the number of people going into rehabilitation,” he said. “Has it decreased the number of people taking substances? No. But that wasn’t the intention.”

The main takeaway?

“Criminalising substance use has not been very successful,” McKenzie said. “If you want to create cartels … and an ingrained substance use problem that just gets worse, then have a war against [drugs]. It will not work.”

McKenzie’s final advice for policymakers: “There are no silver bullets. We have to make choices, and we might have to make sacrifices in order to get where we want to go.”

Listen to more episodes of the Global Health Matters podcast on Health Policy Watch.

Image Credits: Global Health Matters Podcast.