WHO’s Dr Maria Von Kerkhove warns against drinking raw milk.

“Much stronger surveillance” of deadly H5N1 and other avian influenza strains in both domestic and wild animals is needed both in The United States as well as globally so as to head off pandemic risks from variants that could mutate to infect humans more directly. 

A senior World Health Organization official, Dr Maria Van Kerkkove, issued the appeal at a WHO press briefing on Thursday. She also said that WHO ‘always’ recommends drinking pasteurized, instead of raw, milk – due to the risks of contamination by a number of pathogens, including H5N1 virus.

At the briefing, WHO Director General Dr Tedros Adhanom Ghebreyesus also welcomed  the new cease-fire between Israel and Lebanon.  But he said that much more still needs to be done to end hostilities between Israel and Hamas in Gaza – where 90% of Gaza Palestinians are now facing winter in tents, with risks of respiratory diseases, cold exposure and malnutrition even more acute than last year. See related story:

WHO Welcomes Israel-Lebanon Ceasefire – But Onset of Winter Increasing Desperation in Gaza   

‘Epizotic’ of Avian flu in animals worldwide 

While the number of human infections from H5N1 is “still small, relatively speaking,” it is also growing  “not only in the US, but around the world over the last several years,”  Van Kerkhove told journalists.

But what is really “concerning” she added, is the “massive epizootic of avian influenza, including H5N1, but not just H5N1, in wild birds, in poultry, expanding to other animals, livestock, dairy cattle in the United States, but also land mammals, marine mammals. 

“And over the last couple of years, this expansion of H5N1 of avian influenza is putting more people at risk,” she added.  

So far, there have been about 55 human infections reported in 2024, she said, 52 in the United States. All but two of others had “known exposure” to infected animals. And there are extensive investigations that are underway looking at the pathway of exposures in the different cases, to see how people were in fact infected, she added. 

“But what we really need globally, in the US and abroad, is much stronger surveillance in animals, in wild birds, in poultry, in animals that are known to be susceptible to infection, which includes swine, which include dairy cattle to better understand the circulation in these animals, ,” stressed Van Kerkhove. And, she added, “we need much stronger efforts in terms of reducing the risk of infection between animals to new species and to humans.”

The US Department of Agriculture has confirmed cases of infected cattle in some 505 dairy herds in 15 US states since the outbreak was first reported in March, as well as in 50 commercial poultry flocks, according to the latest government data.

H5N1 outbreaks in cattle since beginning of outbreak in March 2024.

More protection of people occupationally exposed also needed

Van Kerkhove also called for more protection of people most at risk – those working with, or handling animals, “making sure that they have the right personal protective equipment, that it’s worn appropriately and properly when they are handling infected animals or even suspected infected animals. 

“We need to make sure that they have testing, that they have access to care, so that we can mitigate any potential spread. We have not seen evidence of human to human infection, but again, for each of these human detected cases, we want to see a very thorough investigation taking place, including further testing of context.

Finally, she added that WHO recommends that the public always drink pasteurized milk rather than raw milk products “for a number of different health benefits…. This is just as important for H5N1 as it is for other pathogens, other bacteria.”

WHO appeals risk a chilly reception from the new US administration 

Robert Kennedy Junior’s photo on X. The nominee for US Secretary of Health and Human Services advocates raw milk consumption and has promised to shift attention from infectious to chronic disases.

The recommendations for stepped-up surveillance of H5N1 in animals and people, as well as  avoidance of raw milk consumption, are likely to meet with a chilly reception in the new US administration of President-elect Donald Trump, who will be inaugurated on 20 January 2024.  

Although US dairy cattle are currently at the epicenter of an outbreak of H5N1 surveillance of both human and animal cases has so far been based largely on voluntary testing and reporting. 

And Robert F Kennedy Jr, Trump’s nominee for the head of the US Department of Health and Human Services (HHS), has long been a proponent of expanding raw milk consumption, and he wants to put a bigger focus on the US epidemic of non-communicable diseases, as compared to infectious disease risks.  

At the same time, concerns over raw milk contamination are rising after some state and county health officials, notably in California, recently began testing bulk milk supplies – finding traces of avian flu in one lot just last week, produced by Raw Farm LLC of Fresno. The company voluntarily recalled the lot.  

A lot of raw milk, was voluntarily recalled by a California manufacturer after Fresno County authorities reportedly found traces of H5N1 virus during bulk testing.

The enhanced testing followed an announcement by the US Department of Agriculture, 30 October, that it would support more bulk milk sampling as well as enhanced testing of dairy cattle herds’ milk samples for H5N1 nationally, in collaboration with veterinarian groups.  

But it remains unclear if Trump’s new DOA nominee, Brooke Rollins, a conservative lawyer and Trump loyalist who grew up on a Texas cattle farm, would continue to expand or restrict such surveillance.  

Meanwhile, Trump’s nominee for the head of the US Food and Drug Administration, Johns Hopkins Professor Martin Makary, is a more conventional pick. But his track record during the COVID-19 pandemic, when he argued against lockdowns, masking, questioned the benefits of vaccine boosters, and incorrectly predicted in February 2021 that “COVID-19  will be mostly gone by April” due to acquired herd immunity, bodes ill for closer tracking of H1N1 infections, or future pandemic preparedness measures. 

Image Credits: Raw_farm_USA, US Department of Agriculture.

Most families in Gaza facing winter cold and rain in tents.

WHO’s Director General Dr Tedros Adhanom Ghebreyesus welcomed the new ceasefire deal between Israel and Lebanon, which took effect Wednesday, but he noted that health needs in Gaza remain huge and “will only increase” with the onset of winter cold and rains.  

While there is an opportunity now to rebuild southern Lebanon’s shattered health infrastructure, the plight of Gazans is only getting worse, he said: 

“A year ago, almost all those displaced by the conflict were sheltered in public buildings or by family members. Now, 90% are living in tents,” Tedros observed, referring to the massive military destruction of schools and other public spaces that has since occurred over the course of the war. 

“This leaves them vulnerable to respiratory and other diseases, cold weather, rain and flooding are expected to exacerbate food insecurity and malnutrition,” Tedros said. 

Northern Gaza ‘blockade’ still limiting access to aid – Tedros

WHO Director General Dr Tedros Adhanom Ghebreyesus.

A continuing Israeli blockade of northern Gaza is limiting the entry of essential resources, “including blankets, fuel and food, all of which are already in short supply,” Tedros added.   

Israel has denied that it is limiting aid deliveries to the area, but it admits that aid distribution is a growing challenge due to the hijacking of deliveries by criminal gangs. Some 101 Israeli and foreign hostages also remain in Hamas captivity in Gaza, for the 14th month, with dwindling prospects for their survival as time goes on. 

Over the past month, Israel leveled thousands of homes and ordered the relocation of tens of thousands of Palestinians away from the sprawling Jabaliya refugee camp and other northernmost Gazan communities in the course of fierce battles with still-active Hamas forces in the area. 

The displacement has occured amidst growing signs that Israel’s hard right leadership bloc and its settler supporters are planning to reoccupy depopulated areas of northern Gaza, contrary to international law – and despite the denials of Prime Minister Benjamin Netanyahu and other top military and foreign ministry officials. 

Critical shortages of medicine and fuel  

Al Shifa hospital 23 November: WHO describes critical shortages of medicines and fuel following recent visit to northern Gaza hospitals.

Most immediately, however,  severe shortages of fuel and medicines, as well as food, in the besieged area pose continued challenges even to the limited functionality of the area’s hospitals, said WHO officials.  

“This week, WHO and our partners conducted a three day visit to the north of Gaza,” Tedros said. “The team visited 17 health facilities, including five hospitals. They saw a high number of trauma patients and increasing numbers of patients with chronic disease needing treatment. 

“There are critical shortages of essential medicines,” he asserted adding, “WHO and our partners are doing everything we can, everything Israel allows us to do, to deliver health services and supplies.”  

Tens of thousands of Palestinians who were displaced from Jabaliya and areas along the border with Israel have now moved south to Gaza City, added said Rick Peeperkorn, head of WHO’s Office in the Occupied Palestinian Territory (OPT). 

“There’s between 100 to 150,000 people from the north who are now actually camping in Gaza City,” he said. 

Huge increase in insecurity, crime and looting

Dr Rick Peeperkorn, head of WHO’s Office for the Occupied Palestinian Territory (OPT)

“There’s a huge need for mental health, psychosocial support, especially also for the health workers,” Peeperkorn said. “And of course, the shortages in supplies, staffing, but also the high influx of trauma patients. And the shortages remain in the key area, energy, as well as antibiotics, surgical supplies, oxygen, IV fluids, etc.” 

In the wake of the progressive destruction of Hamas,  “we have seen a huge increase in insecurity, crime and looting,” Peeperkorn admitted, compounding the problems with delivery of aid.  

On a faintly positive note, WHO this week facilitated the medical evacuation of some 70 patients to Jordan and elsewhere abroad for medical treatment – one of the largest groups to be moved out of the conflict zone since the  Rafah crossing closed, Peeperkorn noted. 

But he called for the re-establishment of more “consistent” medical corridors abroad, noting that with 12,000 chronically ill or injured people waiting to be referred out of Gaza  “if we continue at this pace, we’ll be busy for the next 10 years.” 

Added Tedros, “Once again, the ultimate solution to the suffering is not aid but peace. As we always say, the best medicine is peace.”

Image Credits: @WHO.

Burundi health officials conduct medical consultations and awareness sessions about sexual and reproductive health and mpox with displaced people in camps in Mubimbi and Rumonge.

Despite having the second biggest mpox outbreak in Africa, Burundi has no immediate plans to vaccinate those at risk.

Donated vaccine doses are available to Burundi for free but “vaccine hesitancy” might be playing a part in the government’s reluctance to vaccinate people, according to Dr Ngashi Ngongo, mpox lead for the Africa Centres for Disease Control and Prevention.

Over the past week, Burundi has registered 273 new mpox cases – an 13.8% increase over the previous week – and its first death. Overall, it has over 2,000 cases.

“The problem is not really the availability of vaccines. The problem is more on the country’s side,” Ngongo told an Africa CDC briefing on Thursday.

“During the COVID-19 time, it was a similar experience, where there was hesitancy to embrace vaccination. But toward the end of the response, the government of Burundi had accepted for vaccinations to be introduced in Burundi. We are hoping that it will be the same here.”

Ngongo confirmed that “there was really some hesitation” from the government, who wanted more information. 

“That information is being provided in order to get to the point where we can then convince the government of Burundi to move ahead with vaccines,” said Ngongo.

“The vaccines are ready. As soon as they accept, we should be able to deploy them.”

Burundi is one of the poorest countries on earth and two-thirds of the population live below the poverty line, according to the World Bank.

While 44 of the country’s 49 districts have registered mpox cases, the heart of the outbreak is in the economic capital of Bujumbura, where almost 60% of cases are, according to Ngongo.

Children under the age of 15 account for 42.9% of the country’s cases, the highest percentage on the continent. Clade 1B is dominant. 

Former President Pierre Nkurunziza failed to impose public health measures to control COVID-19. But after his death in 2020, his successor, Évariste Ndayishimiye, gave the go-ahead to vaccinations.

Misinformation campaign

However, vaccination campaigns particularly in Francophone Africa have become the target of disinformation campaigns allegedly fueled by Russia, according to The New York Times. 

Pro-Russian social media influencer Egountchi Behanzin has campaigned against malaria vaccines solely because they were developed in Western countries.

More recently, Behanzin – who has a large social media following and posts daily videos – took aim at mpox vaccines and urged Congolese people to reject them.

He claimed Western countries were involved in “health terrorism”.

Steady growth of mpox

In the past week, Africa has recorded 2,680 new cases (492 have been confirmed) and 22 deaths.

Some 84% of cases are located in the Democratic Republic of Congo (DRC), which recorded 2,261 new cases. The country also recorded 21 deaths, representing 95% of the continental total. 

Burundi and Uganda account for most of the remaining cases, while there are smaller outbreaks in Cameroon, Central African Republic and Liberia.

Gabon, Guinea and South Africa have moved from “active” to controlled, with no new cases in the past six weeks.

Meanwhile, the US and Canada have recorded their first mpox cases in people who have traveled to African countries with outbreaks.

Vaccination campaigns

In contrast to Burundi, Rwanda, DRC and Nigeria have started to vaccinate people at risk. Almost 56,000 people have been vaccinated in seven provinces of the DRC.

Rwanda has already reached 44% of its initial target, and is planning a new strategy for the next phase – “cluster vaccination in hot spots”, said Ngongo.

“Given that in some of the areas, the identification of contacts has remained a challenge, I think entire households are also being considered where there’s clear evidence of proximity and increased risk to those around the confirmed case,” said Ngongo.

The Japanese LC16 has now been included in the World Health Organization’s (WHO) emergency use listing for people aged one year and above.

“Now we are just waiting for the confirmation now from the Japanese government when the three million doses going to arrive in the DRC,” Ngongo noted.

Still a public health emergency

The International Health Regulations (IHR) Emergency Committee has resolved that mpox is still an public health emergency of international concern (PHEIC), WHO Director-General Dr Tedros Adhanom Ghebreyesus told a media briefing on Thursday.

According to a statement from the emergency committee meeting held last Friday (22 November), the “observed dynamics of transmission” of mpox clade 1b in DRC “are changing over time and are diverse across affected health zones”.

Infections have “shifted from adults, where transmission was first observed and appears to have been sustained by contact within commercial sexual networks, to younger age groups, including children, and sustained by household and likely broader community transmission through close physical contact”, it notes.

“Regardless of the circulating mpox clades, adults of 50 years of age or older are less affected, likely due to the immunity conferred by prior vaccination against smallpox,” it notes.

“As we have said many times, we’re not dealing with one outbreak of one virus, but several simultaneous and overlapping outbreaks of different strains or clades of the virus affecting different groups in different places,” added Tedros.

“We still face many challenges to bring these outbreaks under control. We need stronger political commitment to scale up responses activities. We need fully resourced preparedness and response plans. We need further contributions of medical countermeasures, including diagnostics and vaccines. And we need continued transparency and collaboration between affected countries and partners.”

Ipas CEO Dr Anu Kumar at a meeting in Mozambique.

Dr Anu Kumar, CEO of the global reproductive justice organisation Ipas, outlines the impact of a global clampdown on abortion

“Unsafe abortion remains a leading cause of maternal mortality, and it is entirely preventable,” says Dr Anu Kumar, CEO of Ipas, an international reproductive justice organisation. “So there is something we can do about it. We know what to do and we know how to do it. We just need to do it.”

But Kumar concedes that the election of Donald Trump as United States (US) President has ushered in a “pretty grave and serious moment” for reproductive rights.

Trump draws significant support from vehemently anti-abortion Christian conservatives and is widely expected to entrench more anti-abortion measures when he assumes office in late January, both in the US and globally – and this is likely to impact on millions of women and girls, and organisations like Ipas and its partners.

Ipas focusses solely on expanding access to abortion and contraception services and works in 23  countries, mainly in sub-Saharan Africa, Asia and Latin America, as well in the US.

Last year, the organisation helped over 640,000 people to get abortions and over 1.5 million to get contraceptives.

 

Ipas staff member Adeodatus Shukuru, an internally displaced person and peer educator in the Democratic Republic of Congo, with women who have come for treatment at the Ipas mobile clinic.

US domestic impacts

Abortion access in the US has already been curtailed since the national right to abortion was abolished by the Supreme Court in 2022, thanks to conservative Trump appointees to the court.

Since then, 14 US states including Texas have almost totally banned abortion and four others have severely restricted access. Texas has focused its laws on health professionals who perform abortions, introducing lengthy jail terms for them.

This has instilled fear in health professionals to the detriment of patients. Recently, a Texan woman died in childbirth because doctors were too scared to give her a standard procedure after her miscarriage – presumably in case it was misconstrued as an abortion. 

Porsha Ngumezi bled to death because doctors did not give her get a dilation and curettage (D&C) that would have removed pregnancy tissue from her uterus and stopped her haemorrhaging, reports ProPublica. 

In July, a Texan woman was charged with murder for taking abortion pills to end her pregnancy.

“Right after the election, there was a huge increase in sales of medical abortion pills, which is an indicator in the US that women are expecting there to be a crackdown,” notes Kumar, who is based in North Carolina in the US. 

Restrictions on abortion pill mifeprisone

There are a number of different avenues that the future Trump administration can take to limit domestic access to abortion, through the executive, via administrative powers, Congress and the courts.

“One of the most significant paths will be restrictions on the use of mifepristone, one of two drugs that are that is used to provide medical abortions,” says Kumar, adding that 63% of all US abortions are medication abortions. 

Ipas anticipates that the Trump administration will restrict telehealth abortions, while the  Federal Drug Administration (FDA) may remove or restrict access to mifepristone or rescind the licencing of the drug altogether. 

“We could also see the Justice Department enforcing the Comstock Act that has been on the books since 1873, although it hasn’t been enforced in recent decades,” notes Kumar.

This prohibits the mailing and receiving of “obscene materials”, and abortion-related material, devices and pills could be categorised as obscene. 

“That kind of broad interpretation of the Comstock Act could criminalise people for administering surgical or medication abortion pills. And then, of course, there’s the judiciary, which could rule against access to medical abortion pills.”

Global scenarios

An Ipas-trained Natural Leader conducts a community session on safe abortion services in Achham, Nepal

But the US also exports its anti-abortion agenda, particularly to countries that receive US aid. Fifty one years ago, the US introduced the Helms Amendment, which prohibits the use of US foreign assistance money for abortion. This is adhered to by Republicans and Democrats.

In 1984, Republican President Ronald Reagan introduced what has become known as the Global Gag Rule, preventing NGOs that receive US funding from using their own funds to provide abortions or referrals, or lobby for abortion law reform. Every Republican administration has implemented this since it was introduced, while Democrats have rescinded it.

“The last time the Trump administration was in power, they expanded the Gag Rule to apply to all global health funding, which impacted about $12 billion,” said Kumar. “Now the threat is that it will be expanded even further, and it could impact programmes from HIV to water and sanitation to research.”

It could also be expanded to apply to US-based NGOs and foreign governments. 

“We don’t know if that will be the case, but if we do see such a drastic expansion, it will have a dramatic impact on not only Ipas’s work, but the work of all of our partners in this sector and beyond.”

Antiretrovials or abortion?

For example, in South Africa, abortion is legal and provided in the public health system. But  the country also receives US funding for HIV through the US President’s Emergency Plan for AIDS Relief (PEPFAR).

So would South Africa need to choose between providing abortion or antiretrovirals?

“It’s hard to walk through what that would look like,” says Kumar. “It’s quite complex. Very likely, the announcement will be made about the Gag Rule on Day One of the Trump administration and we’ll see whether they’re expanding it and, if so, by how much.

“Then the contract language will come out several months later, and in that contract language, we will actually see how they’re intending on enforcing it.”

But the Gag Rule is also likely to also have a chilling effect on countries that may have been considering liberalising abortion access but decide it’s too high a price to pay given the centrality of the issue for the US, she adds.

Global aid is drying up

There aren’t many countries that can step into the breach left by the US withdrawal of funds for sexual and reproductive health (SRH). The Swedish and the Dutch – historically significant SRH funders, are also under more right-wing governments and are pulling back.

Canada remains supportive, but faces its own election in 2025 and conservatives are strengthening in that country too.

“Potentially other governments could step in, although I have to say I don’t have a long list in mind,” says Kumar.

“The world is in some ways, a much worse place than we were during the first Trump administration. We have at least two active wars going in Ukraine and the Middle East that Europe and the rest of the world are extremely worried about. That is taking not just human lives and resources.”

Alternative to Universal Declaration of Human Rights?

Trump ally Valerie Huber addressing the fourth anniversary of the anti-abortion pact, the Geneva Consensus Declaration, in Washington DC, in front of flags of signatories.

The prospect of the US defunding the UN Population Fund (UNFPA) is “almost a given”, says Kumar.

Its withdrawal from the World Health Organization (WHO) is “pretty likely” because of Republicans’ anger about how the WHO handled the COVID-19 pandemic and the pandemic agreement currently being negotiated.

“But the US withdrawal from these UN technical agencies is really about a broader issue,” says Kumar.

The Trump administration and its conservative allies are proposing the anti-abortion Geneva Consensus Declaration as “an alternative view of the Universal Declaration of Human Rights”, says Kumar. 

“This is a framework that undermines the Universal Declaration of Human Rights and imposes a different worldview, and that is actually what they’re after.”

Glimmers of hope?

“One major area of hope is that the sexual, reproductive health and rights movement has actually been extremely successful over the last 30 years,” says Kumar.

“Sixty countries have liberalised their abortion laws. Only four countries have gone backwards, and the United States is one of them.”

The election of a more liberal government in Poland that is making progress to relax its abortion ban “gave me a fair amount of hope that that the right wing fever may be breaking a little bit”, she added. 

The loss of support of Narendra Modi in the Indian election was also promising, says Kumar, as he has had to “form a coalition government and temper some of his anti-democratic tendencies.” 

Money talks and the US has long used it to force through its ambitions, but Kumar also hopes that countries will “make their values clear and resist some of the the bullying that typically takes place with the US government, especially when it comes to pooled funding mechanisms and working in partnership with the US government”. 

“A withdrawal of of some countries from US partnerships in development systems could send a very strong signal that countries don’t share the same values as the US government does,” she adds.

Image Credits: Ipas, Council on Foreign Relations.

Dr Faustine Ndugulile (centre) flanked by Dr Matshidiso Moeti, current WHO Africa director, and WHO Director General Dr Tedros Adhanom Ghebreyesus after his election in August.

Dr Faustine Ndugulile, the World Health Organization’s (WHO) regional director-elect for Africa, has died while receiving medical treatment in India, Tanzania’s parliament speaker announced on Wednesday.

Ndugulile, aged 55, was due to assume his position as the next leader of WHO Africa in February 

No reasons were given for his death, which has been met with shock and sadness by WHO Director-General Dr Tedros Adhanom Ghebreysus, WHO regions and the Africa CDC.

Ndugulile, a former deputy health minister and ICT minister in his country, has represented the Kigamboni constituency in Dar Es Salaam as a Member of Parliament since 2010 and chaired the country’s parliamentary health committee.

He served as deputy health minister under former President John Magufuli, who denied the existence of COVID-19. However, Ndugulile publicly urged Tanzanians to protect themselves against the disease and this may have cost him his position, according to Tanzanian news outlet The Chanzo Initiative.

Magufuli fired Ndugulile as deputy health minister in May 2020 during the height of COVID-19. Magufuli died in March 2021 aged 61, amid rumours that he had been infected with COVID-19.

Ndugulile was also vice-chair of the global Inter-Parliamentary Union’s advisory group on health. 

Aside from a medical degree, 55-year-old Ndugulile had a Masters degree in public health and a law degree. 

Ndugulile secured 25 of the 46 votes for regional director at the WHO Africa regional conference in the Republic of Congo in August, defeating Dr Ibrahima Socé Fall (proposed by Senegal), Dr Richard Mihigo (proposed by Rwanda) and Dr Boureima Hama Sambo (proposed by Niger). 

In his CV, Ndugulile lists his notable achievements, including “championing the passage of the Universal Health Insurance Bill in 2023, advocating for the implementation of an integrated and coordinated community health worker program and successfully advocating for the ratification of the African Medicine Agency (AMA) convention”.

Describing himself as a “technocrat, politician and policy maker”, Ndugulile has promised to “prioritise strengthening of WHO country offices to ensure timely, relevant, optimal and effective support to the member states”.

He was due to succeed Botswana’s Dr. Matshidiso Moeti, who served as WHO Africa director for two terms. 

 

Delegates at ILGA, the international lesbian, gay, bisexual, trans and intersex association, which held its biggest-ever international summit in Cape Town, South Africa, earlier this month.

The global rise of right-wing governments is threatening sexual and reproductive health (SRH) and LGBTQ rights – but human rights defenders and progressive donors are rallying to mitigate this.

US President-elect Donald Trump is expected to reinstate the Global Gag Rule that prohibits foreign NGOs who get US aid from providing or advocating for abortion on Day One of his presidency. His Defense Secretary pick, Pete Hegseth, is predicted to take action against transgender soldiers in the US Army. 

There will also be a substantial reduction in global aid for SRH and LGBTQ communities as Trump will end US support for these issues, both via the US Agency for International Development (USAID) and by reducing funding for UN agencies.

Several European governments that had stepped up during Trump’s previous presidency (2017-2021) to fund SRH and LGBTQ causes are now under right-wing rule and implementing aid cuts of their own. Others are overburdened with aid to Ukraine.

The Dutch government, now governed by a right-wing coalition, aims to cut its overseas development aid (ODA) by almost one-third next year. Grants to Dutch NGOs that dispensed much of the funds will be cut by 70%.

The Netherlands was the second biggest European donor for SRH, but it did not even mention SRH or LGBTQ issues in its mid-November announcement on development budget cuts. Under health priorities, it only mentions HIV and “preventing harmful cultural practices such as female genital mutilation, child marriage and harmful rites of passage to adulthood”.

In 2022, Sweden, under a centre-right coalition, cut its support for SRH by 17%, (168.5 million Euros) and is planning further cuts. However, it has maintained support for LGBTQ rights.

New LGBTQ funding

Days after Trump’s victory, ILGA, the international lesbian, gay, bisexual, trans and intersex association, held its biggest-ever international meeting in Cape Town, South Africa, vowing to act “in global solidarity against the ongoing anti-rights pushback”.

Shortly before the ILGA meeting, the first-ever Global LGBTI Funding Summit secured $100 million in new donor pledges for global LGBTI rights. But only three governments – Denmark, Germany, and Norway – have pledged so far.

“The Global Philanthropy Project (GPP) mobilized this campaign in response to seeing big risks to global LGBTI funding on the horizon,” GPP deputy director Ezra Nepon told Health Policy Watch.

“The US election results confirm and amplify those risks, and the $100 million in pledged new funds for LGBTI communities will be crucial to help resource and defend movements under attack. With the success of reaching our first pledge goal, GPP has extended the campaign to mobilize another $50 million in pledges by June 2025. Now is the time to step forward and commit big new resources for LGBTI movements and communities around the world.”

Germany and Mexico are co-chairs of the Equal Rights Coalition, a 44-country strong alliance of governments and NGOs formed in 2016 to protect the human rights of LGBTI people. Not a single African country belongs to the coalition although South Africa’s Constitution prohibits discrimination based on sexual orientation.

The work of the coalition takes place largely in thematic groups. The Netherlands, with NGO OutRight, heads international diplomacy efforts but its role is in question given its new right-wing government.

Democracy is not a ‘spectator sport’

Dr Alvero Bermejo, Director-General of the International Planned Parenthood Federation (second left), Mpho Tutu-van Furth (right) and others address the ILGA opening plenary.

Addressing the opening of the ILGA conference, Reverend Mpho Tutu-van Furth warned against assuming that the right to equality had been won.

“Complacency is a kind of drugged drowsiness. When we walk around assuming that what has been won will always be ours, we find that those wins are challenged or they’re eroded or they’re ignored,” said Tutu-van Furth, daughter of legendary anti-apartheid leader Archbishop Desmond Tutu.

“In South Africa, we swallowed that sweet syrup of complacency. Justice had won. Justice was done,” said Tutu-van Furth, now a pastor in the Episcopal Church as the Anglican Church withdrew her license to preach after she married a woman.

“We treated democracy as a spectator sport. Our ballot was the ticket to the game. Cast your vote and watch the government of the day do the best for you. But democracy is not a spectator sport, and your ballot is not a ticket to snooze in the stands. Your ballot is a permission slip that allows you to hold your elected representatives to account.”

Also addressing the ILGA Summit, Dr Alvero Bermejo, Director-General of the International Planned Parenthood Federation (IPPF), appealed for alliances to secure human rights.

“During the HIV crisis, there were strategic partnerships with very different partners,” Bermejo noted. “The space has shrunk. People are quick to call each other out on social media. But we need to re-create the space to make alliances.”

Rights are good for health

Depriving people of rights has negative consequences for health, particularly in the spread of sexually transmitted infections.

“Studies have consistently found that HIV policies grounded in human rights achieve superior results over those that are not rights-based,” UNAIDS notes in its annual World AIDS report released on Tuesday.

HIV prevalence is five times higher among men who have sex with men (MSM) in countries that criminalize same-sex sexual acts, according to UNAIDS, which has made “Take the rights path to end AIDS” its theme for International AIDS Day on 1 December.

“The human rights environment is deteriorating in many countries, and the commitment to multilateral efforts to address global challenges is often fraying,” the UNAIDS report notes.

“These trends are interconnected and threaten to undermine access to HIV prevention and treatment. Contexts that are experiencing democratic retrenchment are frequently those that are increasingly hostile to gender equality and the human rights of people from key populations.”

“Key populations” refers to those most vulnerable to HIV: sex workers, men who have sex with men, transgender people, prisoners and people who inject drugs.

Andriy Klepikov,  executive director of the Alliance for Public Health, one of the largest HIV and TB NGOs in Ukraine, describes the stalemate over human rights as “a war between ideology, prejudice and stereotypes on the one side and evidence-based science on the other side.”

“Countries like Russia are neglecting all the evidence [which shows] that the HIV epidemic is going up as a result of punitive law and repressive policies,” he told a World Health Summit event last year. 

Writing in the UNAIDS report, Elton John notes: “Shockingly, 44% of all new HIV infections worldwide are among women and girls. The risk of acquiring HIV is 23 times higher for gay men and other men who have sex with men than for people in the general population.”

Mpox vaccinations hindered

Mpox can also be sexually transmitted and “most of the cases that were reported in the multi-country outbreak in 2022/2023 were identified among gay, bisexual and other men who have sex with men,” according to the World Health Organization (WHO).

However, in the large mpox outbreak currently affecting Central Africa, only the Democratic Republic of Congo (DRC) is targeting MSM in its vaccination drive – and it can do so as it doesn’t outlaw same-sex relationships.

The DRC’s neighbours – Burundi and Uganda – are facing significant mpox outbreaks yet they are unable to reach this key group because they have outlawed all LGBTQ activities.

Likewise, banning abortion has never stopped women and girls from ending unwanted pregnancies. It has simply driven them to unsafe providers whose methods often maim and even kill them.

Unsafe abortions are a “significant and preventable cause of maternal mortality”, Dr Anu Kumar, CEO of Ipas, told Health Policy Watch.

Approximately 6.2 million women and girls had abortions in Sub-Saharan Africa in 2019, and the region has the highest rate of unplanned pregnancies and abortion-related deaths in the world – 185 maternal deaths per 100,000 abortions, according to  Guttmacher.

Polarised world

“In such polarised and contentious times, it has been heartening to witness so many people coming together, strengthening bonds to resist the anti-rights wave, and keep advancing the human rights of LGBTI peoples,” Julia Ehrt, ILGA World’s executive director, said after the conference.

“This conference has been a testament to the resilience, courage, and determination of our global movement. In Cape Town, we witnessed the strength of our unity, and we are inspired to continue working toward a world where everyone is free to live authentically and without fear.”

UNAIDS also notes that, “although the declining space for civil society in many parts of the world is alarming, there are places where space for civil society is expanding.

“In 2023, civic space opened up in more than 30 countries, including through judicial decisions, the release or acquittal of human rights defenders, or civil society policy victories,” it adds.

“We can elevate the human rights of all people living with or affected by HIV and end AIDS as a public health threat—or we can scapegoat, ostracize and punish the most marginalized people and watch the long-term human and financial costs of responding to HIV increase ever further,” UNAIDS concludes, calling on governments to fulfill their commitments to ending HIV.

However, the path ahead is rocky. Conservatives across the religious spectrum have formed strong alliances with right-wing politicians to ban abortion and promote the “natural family”, which is male-headed, heterosexual and has no space for LGBTQ people.

This alliance has deep pockets and is intent on rolling back a range of sexual and reproductive rights already won in international agreements, replacing them with documents such as the anti-abortion Geneva Consensus Declaration crafted during Trump’s presidency.

Trump’s US will become a poweful addition to the pushback against abortion and LGBTQ rights – currently led by at UN forums by Russia, Iran, Syria, Egypt and Nigeria.

Regional Congress on self-care in Asia-Pacific
Regional Congress on self-care in Asia-Pacific

Last week, stakeholders gathered in Bangkok for the first-ever Regional Congress on Self-Care in the Asia-Pacific to discuss the importance of interventions and policies within the region.

Throughout the proceedings, it was gratifying to see how increasing awareness and support for self-care is resonating regionally – as well as at national and global levels. WHO defines self-care as “the ability of individuals, families and communities to promote health, prevent disease, maintain health and cope with illness and disability with or without the support of a healthcare provider” and considers it essential to achieving Universal Health Coverage (UHC).

The three-day congress focused on topics including digital health, health literacy and environmental sustainability. Co-hosted by the Asia-Pacific Self-Medication Industry (APSMI), the Thai Self-Medication Industry Association (TSMIA) and the Global Self-Care Federation (GSCF), it brought together government officials, healthcare professionals, industry representatives and experts.

The congress opened with the official launch of the Bangkok Joint Initiative on Self-Care of Medical Products: Enhancing Wellbeing in the Asia-Pacific Region. The Initiative highlights the central role of self-care in promoting increased access to health and Wellbeing across the region.

During the Congress, Sylvia Tsai, Chairperson, APSMI, said, “This Initiative is an impressive multi-sectoral collaboration that promises to advance self-care and enhance policy and practice. By working together, we have the power to shape regulatory frameworks, eliminate barriers and create inclusive policies that empower individuals to leverage self-care to make better health and wellbeing decisions.”

It was great to build on the self-care commitments we have seen in the last year, including the endorsement of the Sao Paulo Declaration on Self-Care for Universal Health Coverage adopted last year by Ministers of Health of the Latin American region and the launch of a joint statement by the World Bank, HRP, WHO, UNDP, and UNFPA centered on self-care and sexual and reproductive health in the context of advancing UHC.

Regional Congress on self-care in Asia-Pacific
Regional Congress on self-care in Asia-Pacific

Self-care in Asia-Pacific

Self-care is a fundamental practice that continues to play an important role in healthcare systems in the Asia-Pacific region, which is home to almost 1.9 billion people across 37 countries and areas.

According to our Economic and Social Value of Self-Care report, self-care practices in the region tend to encompass good nutrition, hygiene, exercise, and self-medication. Traditional herbal medicines are prevalent as a form of self-care across many countries, including Korea, Japan and China.

When it comes to policy, there is a critical need to broaden access to self-care in the region to improve the sustainability of health systems. We have observed significant policy developments in Asia-Pacific, including regulation to switch prescription medicines to over-the-counter (OTC) status and policy that simplifies the OTC registration process to expedite the availability of self-care options for consumers (e.g., Singapore).

Importance of health literacy

According to the Global Self-Care Federation’s Self-Care Readiness Index, many people globally and in Asia-Pacific have problems learning about their health because they have difficulty understanding written information.

Self-care statistics
Self-care statistics

Our study found limited health literacy rates in the Asia-Pacific region, ranging from a low of 7.3% in Laos to 51.5% in the Philippines on the other extreme. To address this gap in health literacy, we need to ensure that individuals are well-equipped with skills that allow them to understand their medications and ensure the quality and accessibility of digital health information so that people are able to take charge of their health.

E-labeling, for example, makes product information more accessible and understandable to the public by providing individuals with real-time information on healthcare products, multi-lingual support, improved readability and visual demonstrations. Digitalization can also support the development of e-pharmacies and wider e-commerce channels to improve access to self-care products.

Regional Congress on self-care in Asia-Pacific
Regional Congress on self-care in Asia-Pacific

On the road to 2025

Our ambition has always been to create a healthier world by promoting inclusive health systems and better self-care. We are actively pursuing the adoption of a WHO Resolution on Self-Care—not for the sake of it but because self-care is a fundamental component for the sustainability of our health systems and for the health and wellbeingwell-being of everybody.

Ahead of upcoming global health discussions, including the WHO global oral health meeting and the 2025 UN High-Level Meeting of the UN General Assembly on the Prevention and Control of NCDs, we are advocating for policies that prioritize self-care as a critical element of Universal Health Coverage.

As we move forward, integrating self-care into our health systems represents not just a response to current challenges but a proactive strategy for a healthier future. By empowering individuals with the tools and knowledge to take charge of their health, we create resilience and reduce the burden on healthcare systems.

Together, we can ensure that every individual, regardless of background, has the resources and support they need to thrive.

Let’s commit to making self-care a foundation of our health agenda, paving the way for a healthier Asia-Pacific and a better world.

About the author

Judy Stenmark is the Director-General of the Global Self-Care Federation (GSCF), which aims to create a healthier world through promoting inclusive health systems and better self-care. Judy has had a long-standing career leading global and national NGOs in the musculoskeletal arena, with a previous eight-year tenure as head of the International Osteoporosis Foundation (IOF) in Nyon, Switzerland and nine years leading Osteoporosis Australia before that.

An Australian national, Judy has spent the last 10 years living and working in Switzerland. During this time, she has established a strong network within global healthcare institutions, including the World Health Organization, international scientific academia, and many global pharmaceutical and consumer health companies. She holds a bachelor’s degree in Physiotherapy and a master’s in Public Health.

Image Credits: GSCF.

Kick Big Soda Out campaign
Kick Big Soda Out campaign

The “Kick Big Soda Out!” campaign launched on July 8, 2024 ahead of the 2024 Paris Olympics and ran through the end of the Paralympics. It’s all about holding sugary drinks companies – especially Coca-Cola – accountable for their impact on health and the environment.

To discuss the campaign, Health Policy Watch spoke to Trish Cotter, Global Lead for the Food Policy Program at Vital Strategies.

What is the “Kick Big Soda Out” campaign?

Cotter: Sugary drinks are linked with health issues like Type 2 diabetes, stroke and heart disease. In fact, Type 2 diabetes rates are climbing, with an estimated 537 million adults living with diabetes worldwide and that number is expected to skyrocket to 246 million by 2045. Even further, obesity rates have more than doubled among adults and have quadrupled among kids and teens since 1990. Big Soda companies are also among the biggest plastic polluters and have been caught taking water from communities already struggling to access clean water.


The campaign exposed how Big Soda, through sponsoring events like the Olympics, “sportswashes” away the harm its products cause for public health and the environment by associating them with athletes’ and sports’ greatest moments. The goal was to draw attention to this damaging marketing tactic, and going forward, urge sports organizations to shun the sticky dollars of Big Soda companies and pursue healthier, more sustainable sponsorships.

Who is behind the campaign?

Cotter: “Kick Big Soda Out!” is a movement of almost 100 organizations with the backing of a quarter of a million supporters working to fight Big Soda’s use of sporting events to market unhealthy, environmentally harmful products, especially to kids and teens.

How would you describe the “Kick Big Soda Out” campaign? What were the most significant accomplishments from your perspective?

Cotter: “Kick Big Soda Out!” combined social media outreach, media engagement and grassroots events to end Big Soda’s reign over sport. One of the standout accomplishments of the campaign has been its incredible global resonance. The petition to end Coca-Cola’s Olympic sponsorship garnered over 255,000 signatures from 195 countries, uniting voices from every corner of the world. It also gained the powerful endorsement of 93 organizations, adding their might to end Big Soda’s sport sponsorships. This extraordinary groundswell of support not only showcased the strength of collective action but also cemented the campaign’s impact across public health and environmental communities, making it a true force for change.

Why did the campaign start with targeting the 2024 Summer Olympics, the pinnacle of sporting achievement?

Cotter: For nearly 100 years, the International Olympic Committee (IOC) has given Coca-Cola an unmatched opportunity to sponsor the Olympics and link its brand with fitness and health. This year’s Paris Olympics – estimated to have been watched by over one billion people – provided a prime opportunity to expose how Big Soda leverages such a monumental event to push unhealthy products. It’s a striking and timely example of how sugary drink companies continue to mask their impact on health and the environment.

Why was it important to draw attention specifically to Coca-Cola’s Olympic sponsorship, and what makes this relationship unique?

Cotter: Focusing on Coca-Cola’s Olympic sponsorship was crucial because of the visibility it offers and the Games’ positive image. The long-standing, high-profile nature of Coca-Cola’s sponsorship lets the company market its products to millions, under the guise of “wellness.”

But this is not a new phenomenon. Big Tobacco used to be a leading sponsor of the Olympic Games before evidence showed that cigarette smoking causes lung cancer, emphysema and many other diseases. Just as the companies behind these products were banned from advertising during or sponsoring sporting events, the Olympics’ Big Soda partner should be subject to the same restrictions. Big Soda is the final frontier for sports organizations to sever ties with companies that undeniably harm public health.

It’s also important to spotlight how this partnership has global implications. It gives Coca-Cola executives access to closed door meetings with world leaders and government representatives at the Olympics, enabling them to influence public health policy to protect their profits. It’s this proximity to power that makes this sponsorship deal particularly dangerous.

What strategies did you use to reach and engage different communities and advocates?

Cotter: The “Kick Big Soda Out!” campaign used a variety of strategies to engage diverse communities and empower advocates across the globe. The campaign developed materials that were relevant for different regions and languages, helping ensure that local audiences could easily understand and share the campaign’s messages countering the “sportswashed” image cultivated by Big Soda. Social platforms like Facebook, Instagram and TikTok were key for reaching younger audiences with eye-catching visuals and videos.

Local organizations also hosted events and demonstrations, including one held outside the Mexican Olympic Committee. These grassroots actions helped draw attention to the issues and encouraged engagement and participation.

Education was a big part of the strategy too. The campaign’s materials – fact sheets, backgrounders and social media content – highlighted the health risks of sugary drinks and the environmental damage caused by Big Soda, such as plastic pollution and water exploitation. By linking health and environmental concerns as part of a larger conversation about corporate responsibility, the campaign connected with a wider audience, including groups like Greenpeace.

How do you know if the campaign is working well?

Cotter: The response has been truly remarkable. The participation from diverse sectors underscored the broad appeal of the campaign. Additionally, it quickly spread through social media engagement, reaching over 31 million people and resulting in over 255,000 petition signatures. This momentum clearly shows how effectively the campaign has tapped into people’s opposition to Big Soda’s influence over sports and their desire for change.

Global media outlets also recognized the campaign’s growing influence. Seeing over 430 media mentions—including high-profile op-eds and press releases—confirmed the “Kick Big Soda Out!” mission to bring attention to these pernicious sponsorship deals was extending far beyond the public health and environmental communities. Combined with grassroots support and social media activity, this significant coverage shows how much the campaign succeeded in building this movement. We aim to harness this momentum as the campaign’s supporters continue to put pressure on sporting events to end their relationships with Big Soda.

Have you shared the petition with the IOC?

Cotter: Yes. The IOC rejected the petition by reaffirming its support for its sponsorship deal with Coca-Cola and failing to acknowledge Big Soda’s health and environmental harms.

Since the IOC refused to end its relationship with Coca-Cola, it’s important to call attention to the Coca-Cola Company’s responsible marketing policy, which claims the company does not directly market its products to children under 12. Coca-Cola’s branding could easily be seen throughout the Olympic Games by children of all ages at Olympic venues and on TV broadcasts, digital and social media. While Coca-Cola may claim to not directly target children with its marketing, it is impossible for them to avoid it. The notion that kids were shielded from Coca-Cola’s marketing is absurd and directly contradicts their so-called “responsible” marketing guidelines. It’s clear that any justification for this sponsorship is a weak attempt to placate opponents without major consequences for the soda giant’s bottom line.

Yet, the IOC’s leadership still has an opportunity to re-evaluate their long-standing Coca-Cola partnership. They can lead and clear the way for sponsors that align with the stated Olympic values of health, sustainability and corporate responsibility. The campaign’s organizers and supporters will continue to push a pro-health agenda for the end of Big Soda’s sponsorship of sport, including the Olympics.

How can people see it or continue take part in the campaign?

Cotter: There are plenty of ways to stay involved. Head over to the campaign website (www.kickbigsodaout.org) for updates and resources. While the petition has closed, the website and all “the Kick Big Soda Out!” social media accounts will keep you in the loop about future campaign initiatives.

Are there plans to continue the campaign? If so, what changes do you envision for “Kick Big Soda Out” in the future?

Cotter: Absolutely, this is only the beginning. Like the IOC, “Kick Big Soda Out!” will keep putting pressure on other sports governing bodies to end their sponsorship deals with Big Soda.

There are also many opportunities to tackle sponsorship deals for other unhealthy items, such as ultra-processed products, especially when they target kids and people at risk for poor health. The goal is to create lasting change in how corporations use sport to promote harmful products.

The success of the campaign shows that this movement can continue to grow and push back against corporate influence. “Kick Big Soda Out!” will encourage other global and national campaigns aimed at protecting consumers to explore industry’s unethical marketing tactics like “brand washing” and “sportswashing.” Together, we can put public health and the planet first.

Image Credits: Vital Strategies.

COP 29 in Baku, Azerbaijan.

Baku’s Olympic stadium was always an unlikely arena for the world to strike a landmark climate agreement.

As the world’s first oil town, the Azerbaijani capital’s history is steeped in the fossil fuels driving the climate crisis. Its port launched the maiden voyage of the world’s first oil tanker, and Azerbaijan’s name, derived from ‘Azar,’ the Persian word for fire, is a reference to the natural oil and gas flares that have dotted its mountainous landscape for centuries.

Three flame-shaped skyscrapers tower over modern-day Baku as monuments to fossil fuels’ centrality in Azerbaijan’s story – symbolism reflected in President Ilham Aliyev’s opening declaration of fossil fuels as “a gift from God” and the country’s nickname: “The Land of Fire.”

With Azerbaijan being the third consecutive petrostate to host UN climate negotiations – following Egypt and the UAE – the odds were stacked against COP29 from the start.

The central challenge was finance – how much wealthy nations would pay, and which countries would contribute, to fund developing nations’ clean energy transition and climate disaster response. While previous UN climate summits focused on emissions targets and scientific goals, COP29 marked the first head-on negotiations over funding commitments, making it one of the hardest talks since the Paris Agreement was signed in 2015 in the eyes of veteran negotiators.

With climate change accelerating beyond scientists’ projections – driving global temperatures past 1.5°C for the first time, creating unending droughts in the Horn of Africa, devastating storms in the Caribbean, and floods displacing hundreds of thousands across South Asia – the talks forged ahead.

Debating the ‘quantum’

For two weeks, negotiators from over 200 countries debated the “quantum” – UN-speak for the new climate finance goal under the Paris Agreement – a term borrowed from physics where it describes the smallest possible unit of energy.

As negotiations unfolded, developing nations found “quantum” was darkly fitting: while its original Latin meaning asks “how much?”, wealthy nations’ proposed climate finance matched its scientific definition – the smallest amount possible.

Hours before the final gavel landed early Sunday morning, the entire process appeared on the brink of collapse. It had taken developed countries until the final day of the two-week summit to put their first number on the table – $250 billion per year by 2035.

The outrage from developing countries over the offer was swift. Representatives from small island nations, already watching their homelands disappear beneath rising seas, called it a “death sentence.” Civil society actors described it in terms ranging from “an absolute embarrassment” to “a cruel joke.”

Developing countries, who formed a united front at COP29, demanded a minimum of $1.3 trillion annually to assist countries’ transition away from fossil fuels, adapt to climate impacts, and recover from mounting damages they did little to cause. The figure, based on analysis presented at the summit by independent economists commissioned by previous COP presidencies, was far below what civil society groups demanded, arguing true climate reparations would cost between $5-7 trillion annually.

The final agreement, struck 24 hours after developing nations fiercely rejected the initial offer, barely moved: $300 billion per year by 2035, with the $1.3 trillion acknowledged only as an aspirational target.

COP29 President Mukhtar Babayev hailed it as a breakthrough that would “turn billions into trillions,” while UN climate chief Simon Stiell called it “an insurance policy for humanity” – but only if “premiums are paid in full, and on time.”

“No country got everything they wanted, and we leave Baku with a mountain of work to do,” said Stiell. “The UN Paris Agreement is humanity’s life-raft; there is nothing else.”

‘Betrayal’

June floods in Pakistan killed 1,717. The health impacts of the devastation are still unfolding.

The $300 billion offered to developing nations represents just 4% of global fossil fuel subsidies, which the International Monetary Fund estimates at $7 trillion. It is less than Apple’s 2023 revenue of $383 billion and roughly a third of the US military’s yearly budget. Fossil fuel companies have reaped $1 trillion in annual profits for half a century for extracting the oil, coal and gas fuelling the climate crisis.

“The gavel was hit way too fast and our heart goes out to all those nations that feel like they were walked over,” said Juan Carlos Monterrey Gómez, Panama’s special representative for climate change. “Developed nations always throw text at us at the last minute, shove it down our throat, and then, for the sake of multilateralism, we always have to accept it, otherwise the climate mechanisms will go into a horrible downward spiral, and no one needs that.”

The decade-long timeline for reaching even this modest goal raised concerns, given that the previous $100 billion annual target, set in 2009, was only met last year.

“This outcome is a travesty,” declared the least developed countries (LDC) negotiating bloc, which represents 45 nations and 1.1 billion people. “It sacrifices the needs of the world’s poorest and most vulnerable to protect the narrow interests of those who created this crisis.”

The world’s 46 least-developed countries, home to about 14% of the global population, contribute less than 1% of global emissions. The African continent, with 17% of the world’s population, accounts for just 4%.

“That the developed countries are saying that they are taking the lead with $300 billion by 2035 is a joke,” Mkiruka Maduekwe, Nigeria’s special envoy on climate change, said following the deal. “Let us tell ourselves the truth. It is 3am, and we’re going to clap our hands and say this is what we’re going to do? I don’t think so. We do not accept this.”

India’s lead negotiator, Chandni Raina, criticized the outcome as “abysmally poor,” calling the Baku deal “nothing more than an optical illusion.”

“This, in our opinion, will not address the enormity of the challenge we all face,” Raina said, with rousing applause from delegates in the room. “This has been stage-managed. We are extremely disappointed … [and] oppose the adoption of this document.”

The final text offered only to “note with concern the gap between climate finance flows and needs.” For vulnerable nations, this diplomatic language has run its course.

“We leave Baku without an ambitious climate finance goal, without concrete plans to limit global temperature rise to 1.5°C, and without the comprehensive support desperately needed for adaptation and loss and damage,” the LDC bloc said. “This is not just a failure; it is a betrayal.”

Objects in the future may be smaller than they appear

The Azerbaijani Presidency of COP29 centred the aspiration $1.3 trillion in their communications after the summit.

While the headline figure amounts to a tripling of climate finance – far short of developing nations’ request for 13 times the current amount – the true value of this pledge will be substantially lower when the full bill comes due in 2035.

Climate finance, it turns out, faces the same economic headwinds affecting households worldwide: debt, loans, interest rates and inflation. Combined, these factors have led some observers to view the deal as effectively a step backwards.

Inflation presents the first challenge. When accounting for expected price increases by 2035, the $300 billion target’s real value shrinks considerably. At typical inflation rates, it would be equivalent to roughly $230 billion today – closer to doubling rather than tripling the previous $100 billion goal set in 2009.

The $100 billion finance goal set in 2009 was not indexed to inflation, and developed countries at the negotiations made clear the new target would follow the same approach. 

Debt servicing costs were 20% higher than total energy investment in Africa between 2014 and 2022, according to the IAEA.

The agreement also sidesteps the critical issue of debt as climate change’s financial impacts continue to compound. As storms intensify, droughts lengthen, and countries struggle to repay loans from consecutive recovery efforts from increasingly extreme disasters, developing nations face an ever-deepening climate-driven financial trap.

Vulnerable countries borrow for disaster recovery, face higher interest rates, and lose the capacity to invest in climate resilience, making them more vulnerable to future disasters – a “vicious circle of climate and debt,” according to an expert review released last month.

“Those who are experiencing the worst climate impacts, and contributed the least to the crisis, are paying a double price,” said Sonia Kwami, a lead campaigner at African environmental group 350.org. “Not only is climate change on their doorsteps, but they are also faced with burdensome debts, interest rates, and transition costs that rich countries have evaded for far too long, through an unjust financial system.”

The final text eliminated a clause from earlier drafts requiring at least 50% of finance to be debt-free – a proportion already considered insufficient by developing nations, many facing their worst debt crises in decades. Over three billion people today live in nations spending more on debt financing than education and health budgets combined, according to UN figures.

Do loans count?

The Baku agreement left another critical question unresolved in the debt debate: whether loans should count equally with grants toward meeting the climate finance target. This ambiguity leaves the door open for loans to continue dominating climate finance, despite developing nations’ calls for debt-free support. Some countries heavily favor this approach – France, for instance, provides 86% of its climate finance through loans.

This creates significant discrepancies in accounting. Current climate finance flows measure between $28 billion according to Oxfam, which excludes loans from its calculations, and $116 billion by OECD figures, which count loans equally with grants.

Loans currently make up two-thirds of climate finance for the Global South. If this pattern continues, approximately $200 billion of the new annual target would come in the form of loans – which developing countries argue perpetuates rather than solves their financial challenges.

“COP29 has been a disaster for the developing world,” said Mohammed Adow, director of the climate think tank Power Shift Africa. “It’s a betrayal of both people and planet, by wealthy countries who claim to take climate change seriously.”

‘Some Rich Nations’

The Baku climate deal also leaves unresolved a question that has gained increasing urgency as UN climate talks shift from emissions pledges to financial commitments: who pays?

Countries classified as donors under the UN climate convention, known as “Annex I” countries, comprise about two dozen industrialized nations, including the US, European nations, and Canada. This roster stems from the economic landscape of 1992, when UN climate talks began.

The world’s economic and emissions realities have changed dramatically since. When these categories were drawn, China’s cumulative CO2 emissions were less than half of the European Union’s. Today, China has surpassed the EU in historical emissions while becoming the world’s second-largest economy. Oil-rich nations like Russia and Gulf states have also grown both their wealth and carbon footprints significantly.

This shift has created a paradox at the negotiating table. The EU now finds itself responsible for a smaller share of historical emissions than China while facing pressure to provide more finance. Early drafts of the Baku text proposed expanding the donor list to include wealthy nations like Singapore, China, Saudi Arabia, South Korea, and the UAE. That language was quietly dropped.

The final agreement keeps these nations out of the line of fire. It does not require contributions from China, Russia or Gulf nations – they instead fall in the voluntary category.

Political earthquake

The money problem was further complicated by the political earthquake in the US this month, which loomed over the talks from the get-go. Donald Trump’s return to the presidency in January, along with promises to again withdraw from the Paris Agreement, made current US commitments effectively moot.

The absence of both the world’s largest historical polluter and its biggest economy, the US, alongside its largest current emitter and second-biggest economy, China, creates a massive hole in the global climate finance deal struck in Baku, leaving a small pool of donor countries attempting to shoulder a burden that economists say requires far broader participation.

German Foreign Minister Annalena Baerbock captured the EU’s frustration: “We are in the midst of a geopolitical power play by a few fossil fuel states. Their playing board is the backs of the poorest and most vulnerable countries.”

“What we are seeing here is the last stand by the old fossil fuel world,” Baerbock said, stating that the EU was increasing its financing commitments through 2035. “We are living up to our responsibilities, including as historical CO2 emitters.”

While developed nations point to budgets stretched by war, COVID-19, and inflation, critics question why governments can find money for military spending but not climate action, and why fossil fuel subsidies persist while green energy funding lags.

As promised climate finance from wealthy nations fails to materialise, developing nations are already committing significant portions of their limited budgets to this fight, spending $1 trillion annually from their own resources on adaptation and disaster recovery, according to the United Nations Development Programme (UNDP).

“Developing countries are actually investing hundreds of billions of dollars a year already from their own taxpayers’ revenue,” UNDP chief Achim Steiner told the Guardian this week. “It wouldn’t hurt or harm anyone on the other side of the table to acknowledge that.”

‘Collective amnesia’ on fossil fuels

Following a historic agreement to transition away from fossil fuels a year ago, Baku’s outcome fell silent on the hydrocarbons at the root of the climate crisis.

Just one year after a historic agreement to “transition away from fossil fuels” at Dubai’s COP28, the Baku summit failed to reaffirm that commitment.

The setback comes as 2024 is on track to be the warmest year on record with temperatures temporarily breaching 1.5°C of warming for the first time, and the world tracks toward 3.1°C of heating by century’s end, far exceeding the Paris Agreement’s targets. Scientists warn such warming would trigger catastrophic climate impacts.

“The world made a deal at COP28 to end the fossil fuel era. Now, at COP29, countries seem to have been struck with collective amnesia,” said Shady Khalil, Oil Change International Global Policy Senior Strategist. “With each new iteration of the texts, oil and gas producers managed to dilute the urgent commitment.”

Swiss representatives complained that the draft text had been so “watered down” as to effectively “backtrack from the commitments taken last year.” 

Saudi Arabia, long known as a “wrecking ball” at UN climate negotiations, vocally opposed any document that mentioned fossil fuels in Baku: “The Arab group will not accept any text that targets any specific sectors, including fossil fuels.” 

The fossil fuel industry’s influence was evident throughout the talks. At least 1,773 fossil fuel lobbyists received access to the COP29 summit, according to analysis from the Kick Big Polluters Out coalition. This contingent outnumbered the combined delegations from the ten most climate-vulnerable nations, which totaled 1,033 representatives.

Only three delegations were larger: host country Azerbaijan with 2,229 representatives, next year’s host Brazil with 1,914, and Turkey with 1,862.

Small islands’ voices drown

For small island nations watching their territories disappear beneath rising seas, the stakes of climate negotiations are existential. Many are already losing land to flooding, with some Pacific islands projected to become uninhabitable within decades.

Ahead of the summit, Papua New Guinea’s foreign minister, Justin Tkatchenko, explained his country’s decision to stay away, calling COP29 a “total waste of time” that would produce “no tangible results for small island states.” By the summit’s end, the voices of island nations that made the journey to Baku were drowned out in the rush to reach a deal.

Island countries on the frontlines of the climate crisis, which receive just 1% of current climate finance, had requested dedicated funding to help them access climate finance – a critical need for small states that lack the capacity to navigate complex application processes that often see climate aid flow to better-resourced middle-income nations. Instead, even these minimum allocations were stripped from the final text.

“We had more hope that the process would protect the interests of the most vulnerable and those with the least capacity,” the Alliance of Small Island States, representing 44 low-lying and coastal nations, said in their closing statement. said in their closing statement. “The level of ambition for taking climate action needs to be much, much higher.”

For these disappearing nations, the UN climate talks, however flawed, remain the only path to advocate for their survival. With no other global forum to turn to, they must continue fighting through a process that keeps forgetting them — even as waters continue to rise.”

Image Credits: OXFAM.

The WHO chief was in Rio to attend the G20 summit.

The director-general of the World Health Organization, Dr Tedros Adhanom Ghebreyesus, is “back to work” following an overnight stay in a Rio hospital during his trip to the G20 summit, the WHO chief said Thursday.

The reason for the hospital visit, first reported by the Brazilian paper O Globo, was not disclosed in a statement by the hospital, although media reports cited symptoms of hypertension and labyrinthitis (inner ear infection causing vertigo) as causes for the hospitalization.

“The patient spent the night under observation, underwent all the necessary examinations, which found clinical indicators with no signs of infection,” said Samaritano Hospital, located in a western district of Rio.

“I was discharged this morning and am back to work,” Tedros said in a post on X. “My heartfelt gratitude to the healthcare workers for their outstanding service.”

Tedros, 59, was first attended to on-site Monday at the G20 meeting, a forum of the world’s largest economies, following signs of hypertension but was still able to deliver his speech to world leaders.

He was in Rio attending the G20 summit alongside other G20 and world leaders including UN Secretary-General Antonio Guterres, US President Joe Biden, Indian Prime Minister Narendra Modi and European Union representatives.

“Please take care of your health,” Tedros said.