Smog engulfs Lahore, Pakistan, on Thursday as air pollution levels hit record highs. Some pollutants reached nearly 100 times the World Health Organization’s recommended level, according to IQAir.

BAKU, Azerbaijan — Global and Indian experts at COP29 produced new evidence Thursday calling for clean air standards to become part of nations’ climate commitments, as cities across South Asia’s heavily polluted air corridor battled record-breaking smog.

In Delhi, authorities closed schools up to grade 5 and halted construction as pollution levels soared to almost twenty times the WHO’s safe daily limit. The crisis came just days after Lahore, Pakistan’s second-largest city just 25 kilometres from the Indian border, saw its highest-ever levels of air pollution. 

Under the clear skies of Azerbaijan’s capital, experts from the World Bank, WHO, and Indian health ministry were unanimous that air quality improvement should be included in the new Nationally Determined Contributions (NDCs), the self-determined climate targets nations set under the Paris Agreement. 

“Air quality targets and standards can be a perfect indicator of success if we are successful in targeting the causes of climate change,” Dr Maria Neira, WHO’s health and climate lead, told Health Policy Watch. “If we could select an indicator of how successful we are in achieving negotiations on climate change mitigation, I think we should use the levels of air quality that people around the world are breathing.”

Health experts hope their evidence linking air pollution and climate change will strengthen calls for action at COP29.

Supporting this call for action is a new report released by the Clean Air Fund that shows how tropospheric ozone – a little-discussed ‘super pollutant’ – is linked to 500,000 premature deaths and an estimated $500 billion in economic costs annually. Air pollution from all sources contributes to more than eight million premature deaths each year, with economic costs exceeding $8 trillion, the report found.

The findings aim to support the push for including air quality standards in the third generation of NDCs – binding climate commitments due before COP30 next year under the Paris Agreement. Only a small fraction of countries currently include air pollution safety in their climate plans despite the health threat to millions worldwide.

Clean Air Fund’s founder and CEO, Jane Burston, said tackling super pollutants provides “huge opportunities” for improving climate, health, economic development, and equity.

“We know that developing countries are some of the few that have included things like black carbon in their nationally determined contributions, and that’s because a lot of these deaths and this exposure is happening in countries least able to afford action on it,” she added.

Super-bad for children

Protest by ‘Warrior Moms’, a group for clean air, in Delhi outside India’s health ministry, as air pollution turned ‘severe’ on 14th November, which is celebrated as Children’s Day in the country.

Tropospheric ozone and its super-pollutant siblings – including methane, black carbon, nitrous oxide and fluorinated gases – are collectively responsible for nearly half of global warming to date.

Unlike other pollutants, tropospheric ozone isn’t directly emitted but forms when sunlight interacts with pollutants from aviation, shipping, agriculture and other sectors. Its health impacts can be severe, from reduced lung function to complications in type 2 diabetes and cardiovascular disease. For children, this pollution poses an especially severe threat.

“Young children have smaller lungs,” Dr Soumya Swaminathan, an advisor to the Indian health ministry and former chief scientist at the WHO, explained. “They breathe much faster than adults, and they are shorter, so they’re closer to the ground, where there are more pollutants, and get more respiratory infections.”

Dr Valerie Hickey, who leads the World Bank’s environment department, also placed children at the centre of her argument.

“Your kid got up coughing so bad they couldn’t go to school does not lead on CNN,” she said. “Though if there are huge floods in Valencia, it does. Both are terrible, but [air pollution] is a public health emergency.”

Like climate change itself, air pollution’s threat isn’t only visible in extreme events such as Delhi’s current crisis, where PM2.5 levels have reached almost 300 micrograms per cubic metre.

“Every unit you go above five, you actually have a health impact,” explained Swaminathan, who co-chairs Our Common Air. “Even at 20, 30, 40 you start getting effects on the heart, respiratory system, and brain. So we need to take action to keep it as low as possible.”

“We have to be pragmatic and set interim targets and do a stepwise plan to reduce it,” she added. “That’s what the NDCs are all about.”

‘Smog diplomacy’

Delhi and Lahore, just 400 kilometres apart, face the world’s highest air pollution levels.

Half of the ten most polluted places in the world today are in four countries of South Asia – Pakistan, India, Nepal and Bangladesh. Health experts often say that air pollution knows no borders, an adage now forcing cooperation between long-standing rivals in what’s come to be known as “smog diplomacy.”

India and Pakistan, nations that have fought multiple wars since independence, are finding themselves pushed toward dialogue over their shared air crisis. This week, as their major cities Delhi and Lahore traded places as the world’s most polluted, officials in Punjab, Pakistan’s most populous province, drafted a letter to India seeking talks on air pollution. 

“This is an area of the world where there isn’t always great experience with international diplomacy,” Hickey said. “Countries don’t always like each other, but they’re actually seeing that smog diplomacy is something that can bring them to the table.” 

The outreach comes as hundreds of millions in both countries face severe health risks borne from common problems plaguing both nations: farmers burning agricultural waste, coal-fired power plants, heavy traffic, construction and windless days trapping emissions.

The World Bank has launched a “multi-hundred billion dollar” to address this cross-border crisis, targeting the vast northern plains of South Asia, known as the Indo-Gangetic Plains, Hickey told Health Policy Watch.

The Bank has already committed to several regional projects in India, including a $350 million clean air management initiative plus $5 million grant for Uttar Pradesh, reportedly approved by the state cabinet and a pending $300 million loan plus $5 million grant for Haryana.

Similar programs are planned for Nepal, Pakistan and Bangladesh to address pollution that readily crosses borders due to the region’s geography and wind patterns.

“We need climate diplomacy, as a regional and global issue,” Raja Jahangir Anwar, Punjab’s Secretary for Environment and Climate Change, told CNN. “We are suffering in Lahore due to the eastern wind corridor coming from India. We are not blaming anyone, it’s a natural phenomenon.”

Image Credits: https://x.com/ThePeerAli/status/1856985454072963085/photo/1.

WHO senior technical advisor on measles Dr Natasha Crowcroft

Inadequate immunisation is driving the global surge in measles cases, with an estimated 10.3 million cases in 2023 – a jump of 20% since 2022.

This is according to new estimates from the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC). 

A total of 57 countries experienced large outbreaks in 2023, in comparison to 36 countries in the previous year. 

Europe’s measles cases increased by 200% – from 100,000 cases to just over 300,000 cases.

An estimated 107,500 people, mostly children under the age of five, died of measles in 2023, an 8% decrease from the previous year.

“This slight reduction in deaths was mainly because the surge in cases occurred in countries and regions where children with measles are less likely to die due to better nutritional status and access to health services,” according to Dr Christine Dubray, CDC Measles Elimination Team Lead

But Dr Natasha Crowcroft, WHO senior technical advisor on measles, said it is “very hard with the level of data we have” to be able to say why this had happened.

“Vaccine hesitancy plays a part in all regions of the world, so we know that’s in there somewhere,” said Crowcroft.

However, she said that deaths were in vulnerable communities with high rates of malnutrition, poor health services and often also conflict. 

“In the African region, the number of deaths increased by 37%,” she said. Africa had  4.5 million cases in 2023, and 71% of global deaths.

At least 95% of children need to be vaccinated with two doses of the measles vaccine to prevent outbreaks of one of the world’s most contagious viruses.

CDC and WHO are founding members of the Measles & Rubella Partnership (M&RP), a global initiative to stop measles and rubella.

Sudan
UN chief António Guterres has called the situation in Sudan “a nightmare of violence”.

The death toll in Sudan’s civil war is likely far higher than reported as violence, hunger and disease devastate Africa’s third-largest nation, a new study shows.

More than 61,000 people have died in Khartoum state, the capital region where fighting began 14 months ago, according to research from the London School of Hygiene & Tropical Medicine. Among the dead, over 26,000 were killed by violence – surpassing the United Nations’ nationwide count of 20,178 violent deaths reported by crisis monitor ACLED.

The death count in Khartoum, just one of Sudan’s 18 states, suggests official figures severely undercount the number of lives lost in what the UN and aid groups call the world’s worst humanitarian crisis.

Researchers found starvation and disease are the leading causes of death across most of the country, while violence claims the most lives in Kordofan and Darfur, where ethnically targeted attacks and intense fighting continue.

“Our findings reveal the severe and largely invisible impact of the war on Sudanese lives, especially preventable disease and starvation,” said Dr Maysoon Dahab, lead author of the report and infectious disease epidemiologist at LSHTM. “The overwhelming level of killings in Kordofan and Darfur indicate wars within a war.”

The war has transformed Sudan from Africa’s largest agricultural producer and regional breadbasket into a nation where 750,000 civilians now face famine conditions, driving 11 million people from their homes in what the UN calls the world’s largest displacement crisis. Half of Sudan’s population – 24.8 million people – now depends on aid to survive.

“Sudan is trapped in a nightmare,” Rosemary DiCarlo, UN Under-Secretary-General for Political Affairs, told the Security Council on Wednesday. “The people of Sudan need an immediate ceasefire.”

Healthcare collapse fuels rising death toll

pollution
Khartoum, Sudan.

The war’s deadliest long-term impact may be its destruction of Sudan’s health and sanitation services. Disease and starvation now account for about half of all deaths in Khartoum amid an acute health crisis sweeping the country, the study found.

Eight in ten hospitals in conflict zones have shut down, leading to a sharp rise in deaths from infectious, non-communicable, maternal, neonatal and nutritional diseases that researchers called “significant, unrecorded and largely preventable.”

An unusually heavy rainy season has fueled a severe cholera outbreak, with contaminated water driving more than 28,000 cases across 11 states, and a surge in dengue fever that has resulted in 12 confirmed deaths since July, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA). 

Disease counts, like death tolls, represent only a fraction of the crisis, OCHA said. Millions remain cut off from care as outbreaks spread undetected beyond the reach of Sudan’s devastated health surveillance systems.

Half of Sudan’s population needs humanitarian assistance, yet aid remains out of reach for most. Aid groups “remain unable to reach the vast majority of people in conflict hotspots,” UN emergency coordinator Ramesh Rajasingham told the Security Council on Wednesday.

“Some areas are completely cut off,” Rajasingham said. “We urgently need the parties to ensure the safe, rapid, unimpeded movement of both relief supplies and humanitarian personnel via all available routes.”

‘Invisible’ deaths go uncounted

Aid arrives in Sudan as over half the country faces dire humanitarian needs.

Sudan’s ability to count its dead has long been fragile, with no national census conducted in over a decade. Even Khartoum, the capital region, captured just 3-6% of COVID-19 deaths during the pandemic, researchers estimate.

The war has shattered this already weak system. Morgues and hospitals that typically record deaths are now inaccessible or offline, while military factions have weaponized telecommunications, implementing blackouts that further obstruct data collection.

More than 90% of deaths documented in the new study went unrecorded in official tallies. Sudan’s Health Ministry claims just 5,565 war-related deaths have occurred to date.

Dahab said while the team could not estimate mortality levels beyond Khartoum or determine total war-linked deaths nationwide, their assessment offers the first systematic mapping of death patterns during the conflict. 

“The number might even be more,” Abdulazim Awadalla, program manager for the Sudanese American Physicians Association, told Reuters. “Simple diseases are killing people.”

Foreign powers ‘enabling the slaughter’

As disease, hunger and violence claim more lives, evidence mounts that foreign powers are intensifying and prolonging Sudan’s humanitarian catastrophe.

French weapons have been identified in the hands of the Rapid Support Forces (RSF), Amnesty International revealed Thursday, adding to a complex web of international involvement in the conflict.

“Our research shows that weaponry designed and manufactured in France is in active use on the battlefield in Sudan,” said Agnès Callamard, Amnesty International’s Secretary General. The weapons reached RSF through France’s defence partnership with the United Arab Emirates, which has emerged as a key backer of the paramilitary group.

“To put it bluntly, certain purported allies of the parties are enabling the slaughter in Sudan,” DiCarlo, the UN Under-Secretary-General for Political Affairs, told the Security Council. “Both warring parties bear responsibility for this violence.” 

A UN fact-finding mission released in September found both the RSF and government forces have committed potential war crimes and crimes against humanity. The RSF and allied militias face additional accusations of genocide and using mass rape as a weapon of war, particularly in Darfur.

Despite a UN arms embargo, weapons continue flowing to both sides through neighbouring countries, several of which, including Libya, Chad and the Central African Republic, are major arms trafficking hubs, UN experts say. 

While Egypt and Saudi Arabia back government forces, the UAE, Libya and Russian-linked Wagner Group support the RSF. The UAE has invested over $6 billion in Sudan since 2018, viewing the resource-rich nation as key to expanding its regional influence.

“All countries must immediately cease direct and indirect supplies of arms and ammunition to the warring parties,” Callamard said. “They must respect and enforce the UN Security Council’s arms embargo regime on Darfur before even more civilian lives are lost.”

Image Credits: @UNHCR, State of Air Quality and Health Impacts in Africa .

Testing for mpox will soon be done using tests made in Morocco.

African countries will soon use a PCR test for mpox developed by Moroccan company Moldiag that is cheaper than the Gene Xpert tests currently being used, according to the Africa Centres for Disease Control and Infection (Africa CDC).

“This test was approved after a number of tests were done in the [Democratic Republic of Congo] to ensure that it is sensitive to clade 1b and other clades in Africa,” Africa CDC Director General Jean Kaseya told a media briefing on Thursday.

“The cost is $6 per test, very comparable with [test] kits that are coming from Korea and China,” said Dr Yenew Kebede Tebeje, Africa CDC’s head of laboratory systems.

“But Morocco has also offered that if we can buy in large quantities, they can bring down the cost to $5 per test. As compared to Gene Xperts, this is very, very cheap, even twice as cheap.” 

Dr Yenew Kebede Tebeje, Africa CDC’s head of laboratory systems.

Africa CDC’s Diagnostic Advisory Committee (DAC) recommended the Moldiag test after it has “reviewed the evidence about this test based on set criteria, including independent evaluation data from the  National Institute for Biomedical Research in the DRC and concluded that it fulfilled all the major criteria”, according to a statement from Africa CDC.

Moldiag CEO Nawal Chraibi stated that her company is “dedicated to supporting Africa’s health resilience through the development of locally manufactured diagnostic tools. 

“We believe that strengthening local production is key to empowering the continent in its epidemic preparedness and response, allowing us to respond rapidly and effectively to public health challenges,” added Chraibi.

With 2,836 new cases and 34 deaths confirmed in the past week, Kaseya warned that mpox “is not under control in Africa”. 

The Africa CDC once again highlighted its concern about Uganda’s mpox outbreak, with 184 new cases in the past week.

While mpox vaccination campaigns in the DRC and Rwanda have met or surpassed targets, Nigeria has postponed the start of its vaccinations until 18 November.

Meanwhile, the LC16 vaccines from Japanese company KM Biologics have not yet arrived as agreement has yet to be reached on who assumes liability for adverse events, said Kaseya.

“As you know, every time that a new vaccine is introduced in the country, somebody has to sign for the insurance to be able to take care of possible side-effects,” he added. “I think that’s the issue that is now being discussed with the Japanese government to find someone that will take care of the liability issues. I think that is the only issue that is left.”

Unlike Bavarian Nordic’s MVA-BN mpox vaccine, the LC16 vaccine is licensed for children under the age of 12. Around 38% of those infected with mpox are children.

No new Marburg cases

Rwandan Health Minister Dr Sabin Ntsanzimana

Meanwhile, Rwanda has not had any new Marburg cases for almost two weeks, no deaths in a month and the last patients who were being treated were discharged a week ago, according to Health Minister Dr Sabin Nsanzimana.

While the country has to wait 42 days before it can declare that the outbreak has ended, Nsanzimana said the country has “made very good progress”.

Rwanda also effectively contained the outbreak and no Marburg cases have been detected outside its borders.

Nsanzimana revealed that the index case – a miner who contracted Marburg from fruit bats in a cave outside Kigali – has survived, but his wife and newborn child were killed by the deadly virus.

Rwanda, a small country the size of Haiti, has expanded its surveillance of bats to “all caves in the country”, the health minister added.

“We are now monitoring the movements of these fruit baths with different technology and a different combination of teams, from animal and human health using the One Health framework,” added Nsanzimana. “It’s an opportunity for us to expand our preparedness capabilities.”

Of the 66 people infected with Marburg, 51 have recovered – a comparatively low case fatality rate of 22.7%. There will  also be “continuous” follow-up of the survivors, said Nsanzimana.

Image Credits: Africa CDC.

A patient with diabetes has his blood pressure tested. Integration of care is important for patients’ wellbeing.

ISLAMABAD – Muhammad Waqas is an engineer at a private telecom company. He still remembers the day six years ago in 2018 when he was diagnosed with diabetes at the age of 30. It completely changed his life.

The diagnosis was particularly shocking for Waqas as neither of his parents had the disease, and he had always been physically fit and participated in all kinds of sports since his school days.

“It was September 2018 when I started feeling the need to urinate frequently and experienced weakness and fatigue. I consulted my doctor, who pricked my finger to take a blood sample and checked it with a glucometer. He was also prescribed an HBA1C test,” said Waqas.

Muhammad Waqas was shocked to get a diabetes diagnosis at the age of 30.

The next day, when the test report came, and Waqas’ diabetes was confirmed. Initially, he tried to control the disease through oral medication, but it didn’t work and eventually his doctor put him on insulin.

“I have been on insulin for the past six years, which has completely changed my life. Now, I have to constantly worry about my blood sugar levels and stay in touch with my doctor. I have to carry my insulin bag with me wherever I go,” he said.

World’s highest prevalence of diabetes

Some 33 million Pakistanis – or 26% of the adult population – are living with diabetes, according to the International Diabetes Federation (IDF) citing data from its 2021 report. 

Along with Pakistan, high diabetes prevalence (in black) is an issue in multiple Middle Eastern and North African countries, as well as in Mexico and several Asain-Pacific Island states.

Pakistan has the world’s highest adult prevalence rate. It ranks third in absolute numbers, following China and India which each have a billion people living with diabetes. More than one-third of Pakistan’s cases are undiagnosed, the fourth highest in global rankings. 

In addition, Pakistan’s population with diabetes could nearly double to 62 million by 2045, if more preventative action isn’t taken, the IDF warns. Worldwide, meanwhile, more than half a billion people are living with diabetes. 

Pakistan leads the world in per-capita diabetes prevalence amongst adults.

Trends in the country are even more disturbing in light of Pakistan’s health history, said Dr. Zafar Mirza, former director of Health Systems at the World Health Organization (WHO) in an interview with Health Policy Watch. 

In 1990, diabetes didn’t even appear among the 25 leading causes of disability-adjusted life years in Pakistan. However, in the decade between 2009 and 2019, death and disability due to diabetes increased by 87%.

Waqas adds that people in Pakistan are generally not aware of how to prevent diabetes.

‘Physical activity is like medicine’ 

Exercise is like medicine, but many Pakistan residents don’t do enough exercise.

Zubair Faisal Abbasi, advisor at the Centre for Governance and Public Accountability (CGPA) for food, nutrition, and public health programs, believes that the challenge of diabetes in the ciuntry is the challenge of failed food governance, failure of adaptation to new urban lifestyles, and patchy availability of standard treatments.

Food governance means that Pakistan has been unable to formulate and execute best-practice policies to control dietary risk factors such as free sugars and industrially produced transfatty acids at the population levels, according to Abbasi.

“[The government] has failed to create public awareness that physical activity is like a medicine, which is required for everyone in every age group. In addition, since fiscal allocations for health are low, the country is not able to provide standard treatments such as screening for the pre-diabetic, and treatments for diabetes-related ailments,” said Abbasi.

Mirza attributes the high burden of diabetes in Pakistan to co-existing environmental and genetic factors, with environmental factors as a major reason.  Sedentary lifestyles along with carb- and sugar-heavy diets are considered to be the main causes behind Pakistan’s high prevalence of diabetes, a trend he described, tongue-in-cheek, as “bittersweet”.

Mizra added that genetic factors become more significant due to repeated marriages among close relatives in Pakistan, which has increased the chances of diabetes.

 The burden

Mirza said the vast majority of people with diabetes have Type 2 diabetes associated with lifestyle, while Type 1 or insulin-dependent diabetes, affects a relatively small number of people.

Dr Zafar Mirza

In Type 1 diabetes, the pancreas no longer produces insulin, and patients diagnosed with this type are completely dependent on insulin. Meanwhile, Type 2 diabetes prevents the body from using insulin properly, which can lead to high levels of blood sugar. Type 2 leads to serious physical damage, especially to the feet, eyes, kidneys and heart.

According to official data obtained by Health Policy Watch, around 53% of deaths in the country are the result of non-communicable diseases (NCD), with diabetes being one of the major causes.

Official data said 41.4 % population (53.7% of females and 24.7% males) do not meet the physical activity standards recommended by WHO for the prevention of NCDs including diabetes.

Treatment challenges

Taskeen Arshad, 55, is a housewife who has been fighting diabetes for the last 10 years. Her mother also had the disease, and she died of it at the age of 69. Arshad pays monthly visits to the Pakistan Institute of Medical Sciences, a government-run tertiary care hospital in the federal capital, to get free medicines for diabetes.

She cannot afford to purchase diabetes medicine from a private pharmacy and is dependent on the government’s social security program for her treatment.

“Not every time I get free medicine from this government hospital. Sometimes it’s not available for three to six months. The hospital administration tells us the medicine was not procured because of shortage of funds,” said Arshad.

The non-availability of medicines from the government hospital makes her reliant on relatives to pay for the medicines at private pharmacies.

Noor Mahar, the president of Drugs Lawyers Forum, a watchdog for medicine pricing, said the availability and pricing of diabetes medicine is a serious issue: “Federal government has removed the pricing cap from the medicine which resulted in the price hike of insulin and other medicines up to 400% now.”

 He alleges that sometimes pharmaceutical manufacturers and importers create artificial shortages in the market to increase prices, which results in the suffering of those who depend on the medicines.

“The shortage is not only reported in the private market but also government hospitals usually run short of medicines,” said Mahar.

But Asim Rauf, CEO of the Drugs Regulatory Authority of Pakistan (DRAP), a federal body regulating drug prices and ensuring their availability in the country, said there is no shortage of insulin or other medicines in the country.

He said the prices of medicines in the market vary because of the depreciation of the Pakistani rupee in the international market against the US dollar.

“Whether it is the raw material or the imported medicine, the Pakistan medicine market will be affected by the fluctuation of the dollar rate,” he said.

Primary healthcare focus

Sajid Shah, spokesperson for the Ministry of National Health Services Regulation and Coordination (NHSR&C), said the ministry coordinates with provinces to provide health facilities to prevent and treat NCDs at the primary healthcare level.

The mandate of provinces is to provide free-of-cost services including glucometers, medicines, and other early-detection facilities, and treatment, and also educate people about the disease at service delivery points, he added.

“Every Tehsil Headquarters Hospital (THQ) has an NCD centre for prevention and treatment of diabetes,” said Shah.

However, healthcare officials working at PHC believe that although the government established NCD centres at THQ and District level, on the ground they still lack the facilities and are not functional according to their capacity.

A senior doctor at THQ Gujjar Khan told Health Policy Watch that his facility has an NCD center but it lacks the capacity to provide a full range of services to patients visiting for diagnoses and treatment of diabetes.

“We have glucometers but insulin and medicines for diabetic patients have not been available for the past one and a half years,” said the doctor.

He also said another important issue is the shortage of staff at the PHC level, nearly half of the strength at this level leaves the country because of attractive salary packages offered abroad which impacts the working of NCD centers.

“However all the diagnoses, treatment, and medicine are provided free of cost to the people depending on their availability,” he said.

What needs to be done?

Zubair Faisal Abbasi, advisor at the Centre for Governance and Public Accountability (CGPA)

Abbasi says that the country needs to implement primordial prevention – targeting the social and environmental conditions – as a priority, and doing this involves policy coordination.

“For example, it needs to increase taxes on sugary drinks, ultra-processed foods, and tobacco and look at its patterns of urbanization to reduce the burden of NCDs,” said Abbasi.

Mirza said the current rate of NCDs cannot be dealt with at big hospitals but requires a strong primary healthcare with trained community health workers.

Early diagnosis through mass screening and proper management are vital, as is the integration of service delivery of preventive, curative, and rehabilitative health services, he added.

“Our health system is not equipped to deal with the epidemic of diabetes. It needs sustained and coordinated whole-of-government and societal efforts and the private health sector also has to be taken into the loop,” he said.

Image Credits: WHO/A. Loke, IDF Atlas 2021, IDF Diabetes Atlas 2021 .

Mukhtar Babayev, COP29 President and Dr Tedros Adhanom Ghebreyesus, WHO Director General, announce new ‘COP Continuity Coalition on Climate and Health.’

BAKU – The World Health Organization and United Nations Climate Conference (COP29) host, Azerbaijan, issued a joint call to countries on Wednesday to adopt more  “healthy'” Nationally Determined Commitments (NDCs) in their next set of plans for climate action. The next NCDs are due to be submitted in early 2025. 

But as carbon dioxide (CO2) emissions from burning fossil fuels continued to increase this year over last, reaching record highs, it remains to be seen how this year’s conference appeals, hosted by an oil-flush central Asian nation, might resonate among countries.  

The “health argument” for climate action also was a popular political refrain at COP28 in Dubai. In the year since, global carbon emissions from fossil fuels reached a record high, according to new research that was released Wednesday by the Global Carbon Project. 

Emissions in 2024 are set to rise 0.8% over last year, for a total of 37.4 billion tonnes, stated the Global Carbon Budget, a peer-reviewed analysis of trends involving some 80 research institutions, and hosted by the University of Exeter. Including increased-drought related deforestation and wildfires, emissions are projected to be 41.6 billion tons in 2024, up from 40.6 billion tons last year.

CO2 emissions in 2024 will outpace every other year on record.

That includes a projected increase of 2.4% in gas emissions, 0.9% for oil and 0.2% for coal. They contribute 21%, 32% and 41% of fossil fuel emissions respectively.

The world’s remaining carbon budget is almost exhausted – and time left to meet the 1.5°C target and avoid the worst impacts of climate change – has almost run out, the report stated. 

“The impacts of climate change are becoming increasingly dramatic, yet we still see no sign that burning of fossil fuels has peaked,” said Prof Pierre Friedlingstein of Exeter’s Global Systems Institute, who led the study.

 New ‘Continuity Coalition’ issues the call to make NDCs ‘Healthy’

COP 29 in Baku, Azerbaijan
WHO Director General Dr Tedros Adhanom Ghebreyesus at COP29

The current set of NDCs upon which global climate action is hinged expire at the end of this year. They are already failing by a wide margin to meet the 2015 Paris agreement goal of limiting global warming to 1.5° C. Data released last week by the World Meteorological Organization suggested that the world had already exceeded the 1.5° C limit this year. 

Against that background, the call to adopt more health-focused NDCs will be integral to a new COP29 health initiative that aims to ensure continuity between promises and action on commitments made at this COP and future climate events. 

The initiative, called the Baku COP Presidency’s Continuity Coalition on Climate and Health, was announced by the WHO and Azerbijan’s COP29 presidency at a high-level event on Wednesday. 

“This initiative unites the visionary leadership of five COP Presidencies that span this critical time for action, underscoring a commitment to elevate health within the climate agenda,” said WHO Director General Dr Tedros Adhanom Ghebreyesus.

“With air pollution taking the lives of 7 million people each year, it’s clear that reducing emissions is a fundamental matter of public health,” he said.

‘Continuity Coalition’ aims to enable more coordinated action on health between climate conferences

The “Continuity Coalition” aims to help enhance ambition and enable more coordinated action on health and climate from year to year, asserted Azerbijan’s COP29 president, Mukhtar Babayev, the country’s ecology minister and a former oil executive, at Wednesday’s event. 

“COP26, COP27 and COP28 all added to global efforts on health,” he said. “First, the coalition will bolster ambition by supporting the implementation of existing initiatives and improving synergy between them. It will then ensure continuity from COP to COP by providing a platform for dialogue among presidencies and stakeholders from all parties of the society for climate and health growth. And it will ensure we fulfill past promises and maximize their impact.”

The coalition will be formally launched on 18 November in the presence of the countries that have held COP presidencies over the past three years (the United Kingdom, Egypt and the United Arab Emirates), as well as Brazil, which is hosting COP 30 in 2025 in Rio.  

Days before COP29 opened, Azerbaijan’s Deputy Energy Minister and COP29 CEO, Elnur Soltanov, was filmed surreptitiously by an NGO promoting SOCAR‘s oil and gas projects, saying “We have a lot of pipeline infrastructure. We have a lot of gas fields that are to be developed. We have a lot of green projects that SOCAR is very interested in.”

Babayev declined comment on the remarks to Reuters.

‘Climate Crisis is a Health Crisis’

Despite such headwinds, WHO and other health-focused research and civil society organizations have sought for years to build up a stronger drumbeat around their core message that the climate crisis is a health crisis. 

WHO’s Special Report on Climate Change and Health, issued just last week, estimates that as many as 1.9 million premature deaths annually could be averted by scaling up five interventions: early warning systems for extreme heat, powering health facilities with solar power, water, sanitation and hygiene, cleaner household energy, and reducing or removing fossil fuel subsidies.

A rapid transition to renewable energy, as well as keeping temperatures below the 1.5°C benchmark is critical to avoiding a spiralling death count from climate change in coming decades, the global health agency, backed by hundreds of other scientists, has long maintained.

But few countries so far have heeded those warnings, despite a rising toll of deaths from extreme heat, flooding and other climate-related weather events, as well as drought-threatening food security, wildfires and other visible climate impacts, according to the recent Lancet Countdown Climate and Health report card.

Lancet’s Climate and Health Report Card: Governments, Oil and Gas Companies ‘Fuelling the Fire’ of Cascading Impacts

‘No country can say we didn’t know’

WHO’s Director of Climate, Environment and Health, Maria Neira, at COP29 presentation of the Coalition of COP Presidencies for Health.

Along with changing weather patterns, increased infectious and non-communicable diseases, as well as mental health, are just a few more amongst the long list of health impacts from global warming that countries need to address in their NDCs, said Dr Maria Neira, WHO’s Director of Public Health, Environmental and Social Determinants of Health.

A new guidance document by WHO explains to countries how they can  incorporate health at the heart of their NDCs, she said. The document is called the “Quality criteria for integrating health into Nationally Determined Contributions (NDCs).”

Neira also pointed to the low levels of funding available to the health sector for climate action.

“We have less than 1% of the global funds from climate finance going to health. Governments can divert the finance from fossil fuels subsidies to this,” she said.  

That’s hardly been the case, to date, particularly in Africa, Latin America and Southeast Asia, where investments in clean energy remain comparatively small.

Renewable energy investments (dark blue) as compared to fossil fuels (light blue). Africa, Latin America and South-East Asia lag far behind China, the United States and the European Union.

And although some 1 billion people worldwide lack access to health facilities with reliable energy services, the first health sector project to be approved by the Green Climate Fund in Africa, fails to address critical energy shortages in its investment plan.   

Improving water and sanitation access is a priority for the first-ever Green Climate Fund project in the health sector – but electricity access is ignored.

The initiative, co-sponsored by Save the Children Australia, will help Malawi establish “early warning systems for climate-sensitive diseases,” said GCF Africa Department specialist, Patrick Gitonga, in a video promotion.

“It brings much needed climate resilience building to the health care establishment through the establishment and dissemination of climate-informed health  surveillance and early warning systems for a range of climate sensitive disease, including malaria, diarrhoeal disease, and extreme heat-related diseases,” he said.

While the project aims to improve water and sanitation infrastructure in Malawi’s health facilities, it makes no mention of renewable energy access for energy-starved African health facilities, where one-half of hospitals lack reliable electricity and 15% of clinics have no electricity at all.

Overall, energy-starved Sub Saharan Africa is among those regions of the world to have seen the least investment, public or private, in renewables, even while fossil fuel expansion, which is more expensive and less efficient in terms of expanding electricity access, continues apace.

–Elaine Ruth Fletcher contributed to reporting on this story.

Image Credits: Global Carbon Project , WHO, IEA , Green Climate Fund .

Activists at the World Conference of Lung Health in Bali, Indonesia demand a drop in the price of TB test GeneXpert.

Dozens of tuberculosis (TB) activists took to the stage during the opening of the annual World Conference on Lung Health in Bali, Indonesia, to demand that the price of GeneXpert tests to detect TB is slashed to $5 in low- and middle-income countries. ​

Medical test maker Cepheid and its parent corporation Danaher were asked to reduce the price of GeneXpert tests to US$5 in low- and middle-income countries. ​

While Danaher reduced the price of the standard TB test by 20% in September 2023 from $10 to $8, the test used to detect extensively drug-resistant TB, remains very high at $15.

Research commissioned by Medecins Sans Frontieres (MSF) in 2019 shows that GeneXpert cartridges could be produced and sold at a profit for less than $5 each, said MSF in a statement on Tuesday.

“For the majority of their tests, Cepheid and Danaher continue to charge triple the $5 that they could be selling each test for and still make a profit. This is unacceptable profiteering by the corporations, especially considering Cepheid and Danaher received $252 million in public funding to develop these tests,” said MSF Access Campaign’s diagnostics advisor Stijn Deborggraeve.

“The corporations have also not kept their promise to share an annual audit of their prices that they committed to more than one year ago. Cepheid and Danaher, it’s really time to do the right thing – it’s time for $5 for each GeneXpert test.” ​

The price of the test is important as TB is once again the world’s leading infectious disease killer after a few years of trailing COVID.

Impact of climate change

Climate change and migration are exacerbating the prevalence of TB while “poverty has made it very difficult to reach all patients who may have tuberculosis,” Marian Wentworth, CEO of global non-profit Management Sciences for Health (MSH) told Health Policy Watch. “Connected to that is weak health systems that contribute to the problem as well,” she added.

Some studies have shown that TB infections are rising as temperatures rise, but more research is needed.

Around 3,900 people from about 150 different countries are attending the lung conference organized by The Union, a global health organization that works to eliminate TB.

The world is far from meeting the World Health Organization (WHO) targets for 2025 and 2030, according to its End TB Strategy.

In 2023, there were around 8.2 million new TB cases, according to this year’s World TB report, and 1.25 million deaths.

While there has been improvement since 2015, the TB incidence rate and deaths remain high.

Survivors demand person-centric care

Chapal Mehra, convenor of Survivors Against TB, said that there is a big gap between what the health system thinks is good quality person-centered care, and what a patient believes is good quality person-centered care.

Patients are often less worried about the side effects of TB than pressures like poverty or caregiving responsibilities, he explained.

While survivors get invited to panel discussions they are not involved in policy and decision-making, he added.

“There are a lot of new plans and ideas on how to work with TB-affected communities, but there isn’t enough [patient] involvement in research, in product development. Because what happens is that they develop a product first, and then they come to us and say: Can you make it acceptable to communities?” he said.

This is something the organizers are trying to bridge, they said.

“TB is a social disease. Without community, you cannot cure TB,” said  Zahedul Islam, Chair of The Union’s Community Advisory Panel, who is coordinating an initiative called the Community Connect at the conference.

“With Community Connect, we are trying to bring in the scientific community and build collaboration and foster partnerships with the community,” he told Health Policy Watch.

Gendered impact of TB

Women make up around a third of all TB cases but often lack the social support or access to resources that male patients might have. They are also less likely to seek care for themselves and face delayed diagnosis even when they do.

“We work in Afghanistan, so that’s a very obvious challenge when women can only seek care through other women, right? And it’s difficult to actually strengthen the capacity of women in a country that doesn’t really encourage women working,” said Wentworth.

Women in Afghanistan have been banned from working in aid organizations including the United Nations by the Taliban. The rules are also rapidly changing and being updated making it hard to reach women in the country.

Mehra says that women need different care and a different setting to men, as TB treatment can affect women’s fertility while the stigma can affect their marriage prospects, and a care provider has to be sensitive to those needs.

He added that trans people with TB often get ignored, and this is an issue that a panel he is a part of at the conference would be shining a spotlight on.

Joegene Mangilaya shares an emotional account of battling TB and the challenges the community faces including long treatments at The Union conference in Bali, Indonesia.

Mental health and climate change on the agenda

“We have special sessions on climate change and its impact on TB and the delivery of TB services,” said Carrie Tudor from The Union who is coordinating the development of scientific programme of the conference.

“People with TB suffer depression, stigma and other mental health issues, so making sure that that is more recognized and raising awareness about mental health and TB,”  said Tudor.

The conference is taking place in Indonesia, which accounts for 10% of the world’s TB burden. India (26%), China (6.8%), the Philippines (6.8%) and Pakistan (6.3%) are the other four countries with high TB burdens. These five countries together account for 56% of the world’s TB cases.

Wentworth of MSH is hopeful that greater engagement will help countries to learn from each other’s scientific research and technologies.

“Given all the new technologies and resources to combat TB, I don’t think there’s been a more important time to have a meeting like this to try and figure out what those technologies mean in terms of real-world action,” she said.

Image Credits: MSF , World TB report 2024, The Union.

In Thailand, a patient with multi-drug resistant TB receives his daily treatment.

This week, experts and policymakers are convening at the Union’s World Conference on Lung Health to discuss tuberculosis (TB), the world’s deadliest and most neglected infectious disease. Since the turn of the 20th century, over one billion people have died from TB – a death toll greater than that from malaria, smallpox, HIV/AIDS, cholera, plague and influenza combined.

The official UN target to reduce TB deaths by 75% between 2015 and 2025 is now out of reach. Many commentators believe that the 2030 target of reducing TB by 90% will prove elusive too – unless we see an urgent increase in investments in new tools that will make a dent in the curve of the epidemic.

Promising TB vaccine pipeline

TB scientific advances over the past five years are dramatically improving the way the disease is treated and, just as importantly, they are moving the needle on a long-awaited vaccine, which history suggests will be needed to effectively end TB as a public health crisis.

The 100 year-old BCG (Bacillus Calmette-Guérin) vaccine is still the world´s only vaccine against TB. It is mainly given to babies and young children to prevent more serious forms of TB, such as TB meningitis which affects the brain. However, the vaccine is essentially ineffective for the more than nine million adults and adolescents who develop TB each year.

This could all change in the coming years if one of the three preventative vaccines now in Phase III trials – the IAVI and Biofabri-sponsored MTBVAC, the Gates Medical Research Institute supported M72/AS01E vaccine, and the Serum Institute’s VPM1002 candidate – demonstrates safety and efficacy. 

However adequate funding will be needed to make this a reality. Unfortunately, adequate funding is not something TB – a disease that disproportionately affects the world’s poorest populations – has ever had.

The science has brought us this far and now it’s time to finish the job – we can’t afford to wait another hundred years to finally deliver a broadly effective vaccine. As we await results from clinical trials, we also need to begin preparing now for the rollout of successful vaccine candidates.

Avoiding TB vaccine inequity

A clear understanding of the scale of demand for TB vaccines will be essential to ensure adequate manufacturing capacity is built and sustained to deliver required doses once a new TB vaccine is licensed by regulators and recommended by public health authorities. This is new terrain for the TB response and will be a costly endeavour, requiring significant lead time.

The COVID-19 response provided some valuable insights as to what could be accomplished with adequate investment in clinical development, de-risking of manufacturing scale up, and broad delivery of vaccines. At the same time, it shined a spotlight on inequities in supply across vaccine-producing and non-producing countries and spurred a movement for sovereign regional manufacturing.

TB Vaccine Accelerator Council

The TB Vaccine Accelerator Council – announced last year by the World Health Organization (WHO) in partnership with Ministers of Health from several high-burden countries, investment banks, and leading philanthropic organizations – could help lay the groundwork in the years to come for the effective rollout of new TB vaccines, principally to people living in countries where the prevalence of the disease is highest. It must deliver this goal with the urgency of the COVID response, but with an unwavering commitment to equity that the COVID response lacked.

The efforts of the Council were boosted earlier this year when Gavi, the Vaccine Alliance, decided to include TB vaccines as part of its Vaccine Investment Strategy. Gavi financing will provide a critical lifeline to ensure TB vaccine availability in the 54 Gavi-eligible countries. 

Gavi support will be instrumental, not only in securing the resources these countries need to finance vaccine procurement, but will also support the establishment of delivery pathways to reach adult and adolescent populations who are critical in stemming the tide of new TB infections but fall outside of routine childhood immunization programs.

Challenges facing high-burden countries

 In parallel, however, strategies are needed to support access to TB vaccines in those middle-income countries (MICs) that have transitioned, are transitioning, or were never eligible for Gavi support but face the greatest burden of TB disease.

These strategies must include investment in vaccine delivery platforms and mechanisms for countries to pool purchasing, including regionally, to leverage their collective volumes for better negotiating power. All of us convening at the Union Conference this week should also think about policy solutions that would indirectly allow MICs in invest more in health systems and vaccine delivery, including sovereign debt forgiveness and relief.

According to WHO, accelerating the scale up of vaccines would prevent up to 76.6 million cases, while producing between $372 billion in economic benefits by 2050.  But more importantly, as TB survivor and advocate Kate O’Brien has reminded us—the most important resources are human lives. Each year we stall, each year we fail to muster the investment and political will that TB deserves, more than a million lives are lost. Working together, we can and must stop this from happening.

Shelly Malhotra is Vice President for External Affairs and Global Access at IAVI. She has over two decades of experience in global health focused on harnessing public-private partnerships to facilitate access to innovations.

Mike Frick is a Co-Director of the Tuberculosis program at the Treatment Action Group (TAG). He has been advancing access to preventive options for tuberculosis for over a decade.

 

 

 

 

 

 

 

 

 

 

Image Credits: USAID Asia.

INB co-chairs Anne-Claire Amprou and Precious Matsoso with WHO principal legal officer Steven Solomon.

The pandemic agreement will not be adopted at a special World Health Assembly (WHA) next month as countries still need “more time” to conclude the complex talks.

Co-chairs of the World Health Organization’s (WHO) Intergovernmental Negotiating Body (INB) Ambassador Anne-Claire Amprou and Precious Matsoso broke this news at a media briefing on Monday evening.

The INB is midway through its 12th meeting after 32 months of negotiations. While some member states and stakeholders have cautioned against sacrificing content for haste, the Africa Group in particular was keen for an early adoption of the agreement.

“Member states have made progress on the text to reach a consensus on all the key elements of the pandemic agreement,” said INB co-chair Ambassador Anne-Claire Amprou.

But they “think that there are still work to do, and they want to use the coming weeks of discussions to continue making progress.” she added.

“Today, member states agreed we need to conclude the agreement as soon as possible and continue negotiations into 2025 with the goal of concluding the agreement by the next WHA scheduled in May 2025, so we are moving in the right direction with a strong political commitment by member states.”

Co-chair Precious Matsoso added that negotiators “are actually closer on some issues than we think” and that “broad principles had been agreed on but need more work, especially on some of the final details”.

Matsoso continued: “A clear opportunity exists for a middle ground and a place where there can be political will, trust and commitment so that the world can be better prepared for the threats today and also in future. I’m confident that we’ll reach that.”

Impact of Trump election?

Last week’s US election victory by Donald Trump cast a shadow over extending the talks.  As president, Trump withdrew the US from the WHO in 2020 and has promised to do the same if re-elected, describing the WHO as a “corrupt scam paid for by the US but controlled by China”.

However, when asked about the impact of Trump’s election on the process, WHO principal legal officer Steven Solomon said that the US was but one of the global body’s 194 member states.

“WHO is the UN agency for health. We are an international intergovernmental organization composed of 194 member states. The question relates to the national political decisions of one of WHO’s member countries, and permit me to refer you to the representatives of that country to respond.”

WHO principal legal officer Steven Solomon

‘Complex’ issues

Amprou stressed that member states were trying to create something new and many issues – such as the proposed Pathogens Access and Benefit Sharing (PABS) system – were “complex”.

Negotiators have discussed adopting a framework agreement with annexes on PABS (Article 12) and pandemic prevention (Article 4), the details of which would be decided on later.

However, Amprou said discussion on this is still ongoing: “The question is, how much detail do we need to operationalise the PABS and to operationalise prevention? Should we include everything in the pandemic agreement or in annexes, other instruments, appendices, whatever? 

“How to find the good balance? That’s why there is the option to have a parent agreement and further instruments.”

One of the most practical benefits of the proposed pandemic agreement is that a certain percentage of pandemic products – particularly vaccines and medicines – would be assigned to WHO for distribution during a pandemic.

This percentage started at 20% but has been halved in recent negotiations – but Amprou stressed the percentage was still being discussed.

“What we heard in the room is that there is a very strong commitment from member states to have a meaningful percentage allocated to to the system. So we will see at the end of the discussion.”

Matsoso added that, once that agreement is adopted, it means real work begins “because we must have the Conference of Party, countries must ratify the pandemic agreement, but you also have to ensure that there is operational elements that can help us.”

‘Abject failure’

INB observer Nina Schwalbe , CEO of Spark Street Advisors, described the decision not to call a special WHA in December “an abject failure of the international system”.

Former New Zealand Prime Minister Helen Clark submitted a statement to the INB earlier on Monday saying that the agreement – and its implementation – are “urgent”. 

“As you gather today, a teenager in western Canada has been hospitalized with H5N1. Mpox continues to infect and kill people in central and east Africa. Rwanda is doing its utmost to contain a Marburg outbreak. There are either no, or not nearly enough vaccines, diagnostics or treatments to equitably contain any of these pathogens,” said Clark, who was co-leader of the Independent Panel for Pandemic Preparedness and Response.

“The world is changing rapidly. Deadly pathogens are not waiting for a pandemic agreement to be adopted and to come into force, or for the results of elections.”

The 29th UN climate summit in Baku is the second consecutive COP to be hosted by a petrostate.

As 40,000 delegates’ flights streamed into Baku’s Heydar Aliyev airport over the weekend, battle lines were drawn on the opening day of COP29 in the Azerbaijani capital as developing countries demanded wealthy nations commit trillions of dollars to combat the climate crisis.

The high-stakes climate mega-conference launched on Monday, just weeks after its less prominent sibling, the UN biodiversity summit in Cali, Colombia, collapsed in disarray over the same fundamental question: who should pay to save the planet, how much, and by when.

Negotiators must now agree on a new global climate finance target by 2025 – a deadline set under the Paris Agreement – to replace the current $100bn annual pledge that wealthy nations promised in 2009 but have met just once. This new framework – known as the New Collective Quantified Goal – sits at the heart of talks, earning Baku the moniker “finance COP”.

With climate disasters wreaking trillions in damages worldwide, COP29 is the final opportunity for nations to align on this crucial financing ahead of the end-of-year deadline, yet countries remain deadlocked on nearly every detail of how to deliver it.

“We must be totally honest – current policies are leading us to three degrees of warming, temperatures that would be catastrophic for billions,” COP29 president and Azerbaijan’s minister of ecology Mukhtar Babayev told delegates as proceedings opened in Baku, citing recent findings from the UN Environment Programme pointing to a 3.1°C rise by century’s end.

“We are on the road to ruin,” he said. “Whether you see them or not, people are suffering in the shadows. They need more than prayers and paperwork.”

Last year’s Dubai summit managed what seemed impossible through three decades of climate talks: getting nations to name the “transition away” from fossil fuels, the root of the climate crisis, as necessary to avert the worst impacts of a warming planet.

In Baku, that bare-minimum breakthrough faces its first stress test. Yet hopes raised by the opening ceremony of seizing a historic moment to keep warming within 1.5C quickly gave way to a familiar deadlock – wording disputes delaying the opening plenary by six hours.

“We must do today what yesterday we thought was impossible,” Babayev said. “We are setting these expectations because we believe they are absolutely necessary – this is a race for our lives.”

‘Red alert’

Babayev’s stark warning came as the World Meteorological Organization (WMO) issued a “red alert” confirming 2024 is on track to be the hottest year ever recorded. Temperatures in the first nine months reached 1.54°C above pre-industrial levels, while Earth’s oceans absorbed record heat and glaciers melted at their fastest rate since measurements began in 1953, the UN weather agency found.

“This is unfortunately our new reality and a foretaste of our future,” said WMO chief Celeste Saulo.

Meanwhile, health experts at the talks are pushing to build on last year’s breakthrough health declaration at COP28, arguing investments in healthcare deserve equal status alongside established climate finance pillars of adaptation, mitigation, and loss and damages – warning that rising temperatures pose an unprecedented threat to global public health.

“Wealthy countries must commit to climate finance in the order of trillions to enable the delivery of climate action commensurate with the health risks faced by the world’s eight billion people,” Jess Beagley, policy lead at the Global Climate and Health Alliance, told Health Policy Watch.

“This must be based on grants, not loans, to avoid fuelling cycles of debt, poverty and ill-health. Failure to deliver adequate climate finance is a death sentence for the most vulnerable today, and our children tomorrow.”

Despite a year marked by record-breaking floods, deadly heatwaves, devastating hurricanes and raging wildfires, UN findings published last month found that no country globally implemented any policies with “significant implications” for reducing emissions in 2023 – marking a full year of climate inaction since the previous COP.

“Climate catastrophe is hammering health, widening inequalities, harming sustainable development, and rocking the foundations of peace,” UN secretary-general António Guterres said as talks opened in Baku.

“Those desperate to delay and deny the inevitable demise of the fossil fuel age … will lose.”

The finance fight

Developing nations, led by African and Arab states, are demanding at least one trillion dollars annually in public funds from wealthy countries. But nations including Canada, Japan and EU members argue such sums can only be achieved through private finance and “global investment flows” – the same fundamental disagreement that derailed this month’s biodiversity talks.

The debate is further complicated by questions over which nations should pay. The UN’s definition of “developed countries” dates back three decades, before China and India’s economic rise and corresponding emissions growth.

Recent assessments suggest developing nations require multiple trillions annually to address climate impacts, with some estimates reaching five to six trillion dollars.

While China now matches the EU in historic greenhouse gas emissions, Beijing is expected to remain staunchly opposed to being classified among nations required to provide climate finance, despite its position as both the world’s largest emitter and dominant clean energy manufacturer.

Major carbon polluters themselves face massive climate costs at home. A recent study of 4,000 extreme weather events shows direct damages alone cost two trillion over the past decade, with the US, China and India bearing the greatest losses. The $451bn bill from the past two years does not account for cascading impacts on health and economic activity.

“Let’s dispense with the idea that climate finance is charity,” UN climate chief Simon Stiell said in his opening remarks in Baku. “An ambitious new climate finance goal is entirely in the self-interest of every single nation, including the largest and wealthiest.”

COP29 president Babayev urged nations to see beyond the immediate costs.

“These numbers may sound big, but they are nothing compared to the cost of inaction,” he said. “This investment will pay off. A clear goal sends a strong signal to financial markets, provides certainty for long-term planning, and builds trust for collective action. We must invest today to save tomorrow.”

Health hits home 

As finance dominates the agenda, health experts warn the human cost of inaction is already mounting. The World Health Organization (WHO) estimates climate change and air pollution are driving almost seven million premature deaths annually, while people faced a record 50 days of health-threatening heat in 2023.

The WHO and over a hundred health organisations are pushing to embed health considerations in countries’ climate plans, due for submission ahead of COP30 in Brazil next year.

“Health workers are seeing the impacts of climate change firsthand, in the suffering of patients and communities they serve,” said Jeni Miller, executive director of the Global Climate and Health Alliance. “It is time for all governments to demonstrate readiness to protect people’s lives by getting serious about bold climate action … and spell out how and when they will achieve the fossil fuel phase-out promised at COP28.”

The global health coalition’s joint report demands any agreement on loss and damage compensation address the health impacts on climate-vulnerable communities. Global health advocates are also pressing for stronger protections for curbing industry influence in climate talks, citing concerns industries that harm global health in climate policymaking.

Conflict of interest concerns from the health community are particularly acute in Baku. Last year’s COP28 Dubai summit, led by oil executive Sultan Al-Jaber, saw more fossil fuel industry representatives than health sector delegates, with a record 2,456 fossil fuel lobbyists attending – nearly four times the number at the previous COP.

Transparency International warned ahead of the Azerbaijan summit that talks in Baku face similar risks of industry influence, prompting WHO to call for restrictions on fossil fuel industry participation in climate negotiations.

WHO: Climate Action Would Save Two Million Lives A Year

The human toll of climate change was brought home by the UN climate chief, as he stood beneath a photo of himself comforting an elderly neighbour in his Caribbean homeland of Grenada after her house was destroyed by a hurricane.

“At 85, Florence has become one of the millions of victims of runaway climate change this year alone,” Stiell said. “There are people like Florence in every country on Earth. Knocked down, and getting back up again.”

WHO estimates nearly 2.5 billion workers are now exposed to dangerous heat levels annually, while extreme weather events are driving increases in trauma and mental health problems.

Ahead of the summit, the UN health agency estimated urgent climate action could save two million lives each year through five key interventions, including heat warning systems and clean energy transitions.

“Health is the argument we need to catalyse urgent and large-scale action in this critical moment,” said Dr Maria Neira, WHO’s health and climate lead. “We’re putting forward this very strong health argument to ensure no one can leave COP29 claiming they didn’t know climate change is affecting health.”

Climate crisis in the hands of a petrostate – again

Mukhtar Babayev, who spent 26 years at Azerbaijan’s state-owned oil and gas company Socar, takes over the presidency of UN climate negotiations from Sultan Al-Jaber, CEO of the UAE’s national oil giant ADNOC.

The UN climate process faces a deepening credibility crisis as Azerbaijan becomes the second consecutive petrostate to host the talks, with fresh revelations about fossil fuel dealings casting a shadow over proceedings in Baku.

“Actions speak louder than words,” Sultan Al-Jaber, the outgoing COP28 president, declared at the opening ceremony. Yet his home country, the UAE – the first nation to submit its third-generation climate pledge – is planning a 34% expansion in fossil fuel production by 2035.

Al-Jaber’s address also hailed COP28’s Oil & Gas Decarbonization Charter as “the most meaningful and comprehensive private sector partnership on decarbonisation to date.” But the voluntary agreement, largely written by the fossil fuel companies that signed it, appears toothless.

Analysis by Global Witness found signatory companies – from ExxonMobil and BP to national oil companies like UAE’s Adnoc – are set to collectively emit over 150 billion tonnes of CO2 by 2050, more than 60% of the planet’s remaining carbon budget to limit warming to 1.5C.

The charter “only commits signatories to ‘net-zero operations’ by 2050,” the analysis found, covering just production, not the burning of fossil fuels. “This means that up to 90 percent of these companies’ true carbon footprints aren’t covered by the pact.”

Azerbaijan’s climate credentials appear equally conflicted. State oil company SOCAR, which accounts for 90% of national exports, struck deals potentially worth more than $8bn while preparing to host COP29.

“The findings appear to confirm a pattern of petrostates using UN climate talks – which are designed to reduce greenhouse gas emissions – as an opportunity to clinch oil and gas deals,” Global Witness said, noting similar $100bn dealings by the UAE’s ADNOC in the run-up to its COP presidency.

The summit’s leadership has also raised eyebrows. COP29 president Mukhtar Babayev, a former oil executive who spent 26 years at SOCAR, faced fresh controversy after a senior COP29 official was caught on camera appearing to utilize the summit’s platform to make oil deals – echoing a near-identical incident involving Al-Jaber last year.

Leadership vacuum

Donald Trump’s promise to “drill baby, drill” amid record oil production is estimated by experts to be the final nail in the coffin for the 1.5C target.

The talks face additional headwinds as world leaders representing over half of global emissions stay away.

US president Joe Biden, Russia’s Vladimir Putin, the EU’s Ursula von der Leyen, China’s Xi Jinping, and India’s Narendra Modi are all absent, while only two G7 leaders – British Prime Minister Keir Starmer and Italian Prime Minister Giorgia Meloni – plan to attend.

Donald Trump’s election victory has also cast a dark shadow over COP29. The incoming president, who dismisses climate change as a hoax, withdrew from the Paris Agreement in his previous term.

His promised expansion of US fossil fuel production – already at record highs – could add more than 4 billion tonnes to US emissions by 2030, effectively ending hopes of meeting the 1.5C target, experts say.

“It is clear the next administration will take a u-turn,” John Podesta, Biden’s climate policy advisor, told reporters in Baku. Yet he insisted the fight transcends US politics, pointing to the Inflation Reduction Act – America’s largest ever green investment – as proof of lasting progress.

“The fight is bigger than one election cycle in one country,” Podesta said. “This is not the end of our fight for a cleaner, safer planet.”

Trump isn’t alone

Estimated embodied emissions in upcoming licensing rounds in the next six months (top ten countries), according to IISD.

But the global emissions challenge extends beyond American politics: Major economies across the globe are undermining global climate goals by scaling up fossil fuel production.

An analysis published last month by the International Institute for Sustainable Development shows the US, Norway, Australia, Saudi Arabia, Russia, India and China among the top issuers of new drilling permits in the past year. All have more fossil fuel permits planned – potentially locking in expanded oil production for decades.

Some nations are already giving up on the process. Justin Tkatchenko, Papua New Guinea’s foreign minister, called COP29 a “total waste of time” that stands to produce “no tangible results for small island states.”

Stiell, the UN climate chief, whose own Caribbean island home faces rising seas, pushed back.

“This UNFCCC process is the only place we have to address the rampant climate crisis, and to credibly hold each other to account to act on it,” Stiell said. “We know this process is working. Without it, humanity would be headed towards five degrees of global warming.”

Climate activist Greta Thunberg, voicing the frustration of young people around the world with the UN climate process, didn’t mince words.

“Another authoritarian petrostate with no respect for human rights is hosting COP29,” she said, explaining her decision not to attend this year’s summit. “COP meetings have proven to be greenwashing conferences that legitimise countries’ failures to ensure a livable world.”

Image Credits: Gage Skidmore.