The Caribbean is still recovering from the damage caused by Hurricane MelissaExtreme weather events affected almost every region in the world in 2025.

Hurricane Melissa’s $60 billion path of destruction through the Caribbean. Cyclones in Mozambique. Typhoons in the Philippines. Floods in Nigeria, the United States, India and Viet Nam. Wildfires in California and Korea. Heatwaves from Europe to East Asia.

These are some of the extreme weather events captured by the World Meteorological Organization’s (WMO) State of Global Climate Report for 2025 – a grim read as the globe reels from the cumulative effect of 11 of the hottest years ever recorded.

“Extreme events, including intense heat, heavy rainfall and tropical cyclones, created challenges for virtually every continent, and are a key way that societies are experiencing a changing climate,” Ko Barrett, WMO Deputy Secretary-General, said at the launch of the report.

“Planet Earth is being pushed beyond its limits. Every key climate indicator is flashing red,” said United Nations Secretary-General Antonio Guterres in a recorded message at the launch.

“The Earth’s energy imbalance, the gap between heat absorbed and heat released, is the highest on record. In other words, our planet is trapping heat faster than it can shed it,” Guterres warned.

Some of the key extreme weather events for 2025.

“Greenhouse gas concentrations are higher than at any point in hundreds of thousands of years. Global temperatures continue to rise, and humanity has just endured the 11 hottest years on record. 

“Oceans are absorbing epic levels of heat, fuelling ever stronger storms. Glaciers and sea ice are vanishing and sea levels are relentlessly rising.”

Guterres added that these findings are not confined to charts and graphs: “They are written into the daily lives of people in families struggling as droughts and storms drive up food prices. 

“In workers pushed to the brink by extreme heat, in farmers watching crops wither; in communities and homes swept away by floods.”

Ko Barret, WMO Deputy Secretary-General.

Greenhouse gases reach reord levels

“Concentrations of three key greenhouse gases, carbon dioxide, methane and nitrous oxide, reached record levels in 2024, which is the last year for which we have consolidated global numbers,” said WMO scientist John Kennedy.

Carbon dioxide levels were 152% higher than the pre-industrial base, methane was 266% higher and nitrous oxide was 125% higher.

The year 2024 also showed the single biggest one-year increase on record, with data from individual sites around the world indicating that levels of these greenhouse gases continued to increase in 2025.

Greenhouse gas increases in 2024.

Energy imbalance

Global energy imbalance 2025

The WMO has introduced a new measure: the Earth’s energy imbalance, which “measures the rate at which energy enters and leaves the Earth’s system”. 

Kennedy explained that, in a stable climate, the energy coming in from the sun is balanced by the energy going out from the climate system. 

“However, in the current climate, there is an imbalance. We have the same amounts of incoming energy, but there’s less outgoing energy due to the increased concentrations of greenhouse gases.

This positive imbalance, with energy accumulating in the Earth’s system, means the Earth is warming. Although it has been warming since 1960, the rate at which it is warming is speeding up – initially from around 0.13 watts to 0.3 watts in 2025.

“That energy is not accumulating evenly,” said Kennedy, with the oceans absorbing 91% of that accumulating energy, 3% going into melting and warming ice, 5% being absorbed by the land, and 1% warming the atmosphere. 

Hottest oceans on record

“Over three billion people depend on marine and coastal resources for their livelihoods. They’re living off the ocean. Nearly 11% of the global population lives on low-lying coasts directly exposed to coastal hazards, so they’re very vulnerable to things like sea level rise,” said Kennedy.

The oceans are warming, with 2025 recording the highest ocean heat on record. And the rate of ocean warming is speeding up, with the rate between 2005 and 2025 more than twice that observed between 1960 and 2005

As ocean water warms, it expands. This, melting ice and the transfer of water from the oceans to land, is causing the sea level rise to rise. Like with hear, the rate of sea level rise is faster from 2012 to present than fbetween 1993 and 2012.

The ocean continues to absorb carbon dioxide, playing a fundamental role in the climate system. 

It is estimated that the ocean has absorbed around 29% of the carbon dioxide emitted by human activities in the past decade, but this has reduced the ocean’s pH, making it more acidic and harming coral reefs and other sensitive areas that provide food and shelter for marine life. 

Glaciers melting faster

Around 3% of the energy trapped in the Earth system is melting ice, both ice sheets and glaciers. WMO has tracked glacier melt since 1970, and it has continuous records for a set of reference glaciers across 19 global mountain regions.

Like with other climate trends, the ice has started melting faster over the past few years.

“In 2025, our glaciers continued to retreat, and ice continued to melt. The warming ocean and melting land-based ice are driving the long-term rise in global mean sea level,” said Kennedy.

Global mean temperature

Despite 2025 being in a La Niña weather cycle, where cooler air is expected in contrast to the hotter El Niño cycle of  2024, it was “the second or third hottest year on record, depending on the data set used”, said Barrett.

“In 2025, global mean temperature was about 1.43º C above the 1850-1900 [pre-industrial] baseline. Between 2015 and 2025, we experienced the hottest 11 years on record,” she said, adding that this had been corroborated by nine different data sets.

“The past 11 years, in all nine of these datasets, are the warmest years on record, and the past three years are the three warmest.”

Greenland, northern Canada, western Europe, Fennoscandia, the Mediterranean and many parts of Asia experienced significant warm anomalies in comparison to other regions, according to the report.

Referring to the  last 11 years, the hottest on record, Guterres said that “when history repeats itself 11 times, it is no longer a coincidence, it’s a call to act.”

“Climate stress is also exposing another truth. Our addiction to fossil fuels is destabilising both the climate and global security. Now more than ever, we must accelerate the just transition to renewable energy,” said Guterres.

Image Credits: WMO.

physical activity heat climate change egypt
A community gym for women in a church in Upper Egypt is empty during a heatwave.

Climate-change related temperature increases are making physical exercise more uncomfortable and dangerous, especially for people in lower-and-middle income countries. A new study from The Lancet estimates this could lead to half a million more premature deaths and aboout $2.5 billion dollars a year in lost economic productivity.

In a village in Upper Egypt, a women’s-only gym complex remained empty and idle as temperatures soared past 40℃ last summer. The women were instead mostly home, sheltering from the intense heat and sun. Their doctors had told them to keep active to stave off the many chronic diseases that plague the village. But in this heat, not even leisure walking through the village where I was a guest and volunteer in July 2025 was an option.

Rising temperatures due to climate change could put routine physical activity out of reach for millions of adults by 2050 – resulting in a about 500,000 more premature deaths and $2.5 billion in lost productivity annually, according to a study just published in The Lancet Global Health.

The study builds on evidence linking climate change-related exposures to a host of poor health outcomes, from direct health impacts like heatstrokes and kidney damage, to the spread of infectious diseases and worsening air quality.

Countries in already warm regions like the Middle East, Central America and the Caribbean, Sub-Saharan Africa, and South-East Asia, are likely to experience the brunt of declining physical activity rates, predicts the study, authored by researchers in Argentina, Chile, Colombia and Ecuador.

‘Profoundly inequitable’

 

The WHO recommends at least 150 minutes of moderate-intensity activity, 75 minutes of vigorous-intensity activity, or an equivalent combination per week.

“Because these exposures co-occur disproportionately in tropical LMICs,” wrote the authors, “where air-conditioning penetration, shaded public infrastructure, and discretionary leisure time are scarce—the resulting burden is profoundly inequitable.” 

As is, a third of adults worldwide fail to meet the World Health Organization physical activity guidelines. The WHO recommends a minimum of 150 minutes of moderate intensity or 75 minutes of vigorous intensity physical activity on a weekly basis. Declining physical activity rates are linked to cardiovascular diseases, cancer and diabetes, poor mental and brain health, and an estimated 5% of all adult deaths.

“Lives are becoming increasingly sedentary through the use of motorized transport and the increased use of screens for work, education and recreation,” says the WHO.

Heat drastically affects how active people can be, according to the group of Latin American-based researchers. That includes not only leisurely activity, like playing a sport or running, but also occupational physical activity and active transport like walking or cycling.

The researchers analyzed self-reported data from 156 countries between 2000 and 2022 to predict how rising temperatures could affect physical activity in the coming decades.

The implications of fewer opportunities for physical activity due to heat translates to a estimated 470,000-700,000 more premature deaths annually and between $2.40 and $3.68 billion in productivity losses, depending on the scenario of temperature increase. 

Lower- and middle – income countries hardest hit

Climate change “hotspots” are expected to see the largest declines in physical activity. Change in physical inactivity under the most extreme of three climate warming scenario.

The burden of reduced exercise falls most heavily on already warmer equatorial regions, where physical activity is projected to decline 4% for each month spent over 27.8℃ (82℉). Globally, that number is 1.4%, while in lower-and-middle income countries (LMICs), the study authors estimated a 1.85% decline. 

Those living in the climate change “hotspots” of Central America, the Caribbean, eastern sub-Saharan Africa, and equatorial southeast Asia are more susceptible to increases in physical inactivity, the authors found.

A hazy day in an Upper Egyptian village. High temperatures combined with poor air quality make outdoor exertion difficult-and dangerous.

“Outdoor labourers, street vendors, and subsistence farmers cannot easily shift physical exertion to cooler hours,” wrote Dr Christian García-Witulski of the Pontificia Universidad Católica Argentina, the lead study author. 

Furthermore, women and adolescents in LMICs face additional barriers to exercise, he noted and already have lower rates of exercise. “[They] often lack access to climate-controlled recreational spaces; and public health budgets in these settings are least able to absorb downstream cardiometabolic costs.

In higher-income countries, where adaptation to rising temperatures such as indoor gyms and air conditioning is perhaps more accessible, the authors projected no statistically significant change.

A ‘feedback loop’ between heat and sedentary behavior

Map of physical inactivity for women
Women already have a higher prevalence of physical inactivity, per a 2024 Lancet Report.

The connection between temperature and the decline in physical activity has several pathways, the authors note.

Physiologically, “heat elevates skin blood flow and sweating, increasing cardiovascular strain, dehydration risk, and perceived exertion.” In addition, high vapour pressure and poorer air quality from smog make breathing uncomfortable, pushing people to avoid outdoor movement – perhaps taking the bus or driving instead of walking to work or school – and staying inside air conditioning.

Globally, the share of households with residential AC is projected to grow from 27% to 41% by 2050, according to a 2024 Nature modeling study. This could further exacerbate sedentary behavior, as air conditioned spaces provide cool refuge but do little to encourage being active. 

This “reinforces a feedback loop between heat and physical inactivity,” García-Witulski wrote.

Rise in premature deaths, lost productivity

Outdoor workers are often exposed to disproportionate amount of heat. The study did not differentiate between occupational, leisurly, or transporation-related physical activity.

Because measures of physical activity also include occupational settings – like agriculture, construction, and other outdoor jobs – heat-driven physical inactivity also threatens economic output. 

Higher temperatures are linked to reduced muscular strength, impaired cognition, and poor sleep – all translating into lower on-the-job performance and higher absenteeism, the authors note.

“Outdoor labourers, street vendors, and subsistence farmers cannot easily shift physical exertion to cooler hours,” García-Witulski and colleagues wrote.

This all means that the model estimated between $2.4 and 3.7 billion in economic losses attributable to rising temperatures, depending on the warming scenario; the study looked at three. Along with that are the projected premature deaths linked to inactivity – 470,000 to 700,000 additional deaths globally. 

Lancet physical activity climate change table
Mortality attributable to physical inactivity by region.

“Physical inactivity is a silent threat to global health, contributing significantly to the burden of chronic diseases,” said Dr Rüdiger Krech, Director of Health Promotion at WHO during the release of WHO data on the topic last year.

García-Witulski and her colleagues undertook this research as part of the Lancet Countdown project tracking progress on health and climate change in Latin America. And though they found that warming temperatures will intensify sedentary behaviors, the authors noted that their modeling had several limitations.

For one, the study relied on self-reported physical activity from its 5.7 million participants, instead of measurement devices, potentially leading people to over-or-under report their activity levels. They also examined only annual, national physical activity averages – and did not differentiate between the kind of physical activity such as leisure, occupational, or transport.

And lastly, the authors only examined temperature, and not any other metric of climate change such as extreme weather events. 

Building heat resilience in cities

Regardless, the authors strongly argued for policies that would make cities heat resilient: “Without stronger mitigation, rising temperatures alone could undermine—or even reverse—a substantial share of WHO’s target of cutting global physical inactivity by 15% by 2030,” they wrote.

Interventions such as expanding shade and tree cover, expanding access to cooling centers, and walking and cycling-friendly roads are all part of creating more resilient cities. 

Adding in air conditioning to the women’s gym in the Upper Egyptian village could also encourage more users in peak summer heat. “They still need the exercise,” said the volunteer who runs the facility. 

The study authors echoed this sentiment: “[T]reating physical activity as a climate-sensitive necessity—rather than a discretionary lifestyle choice—will be essential to prevent a heat-driven sedentary transition and its accompanying surge in cardiometabolic diseases and economic losses.”

 

Sophia Samantaroy spent seven months in Egypt as a research fellow with the non-profit Coptic Orphans in 2025. She also contributes to Health Policy Watch as a reporter covering environmental health, chronic and infectious diseases, and US public health policy.

Image Credits: S. Samantaroy/HPW, WHO, The Lancet, The Lancet Global Health, Mario Spencer/Unsplash, The Lancet.

In February, Cyclone Gezani devastated Toamasina, the second-largest city in Madagascar. Climate change is increasing the intensity and frequency of cyclones.

Climate resilience is a key theme of the World Health Summit’s regional meeting in Nairobi 27-29 April, which is bringing leaders together to address the structural realities of health security across the continent and advance a transformative reform agenda.

In some parts of Africa, like Ghana, December marked the beginning of the Harmattan season characterized by dry, dusty and cooler winds. However, over the past few years, changes in climate have interfered; temperatures are sometimes too high, whereas in different regions, there are sudden storms, and extended dry spells are becoming more frequent. These changes can be deceptive, but they are already causing grave health effects.

Climate change has been far too frequently conceptualized as an environmental or economic problem, a matter that can be handled by government agencies alone. In Africa, climate shocks are already redefining the disease patterns, essential health services and the vulnerabilities of health systems. 

Climate change is no longer a future health threat but an escalating challenge today. The challenge that policymakers and health leaders are facing today is not only the climate change impacts on health, but also whether the African health systems in are able to absorb, adapt, and respond to the increasingly frequent and intensifying climate shocks.

Increasing temperatures, extended droughts, and floods are changing the epidemiology of disease on the continent. This includes the spread of the diseases into new geographies through vectors, whereas water scarcity and flooding contribute to the regular outbreak of cholera and other waterborne diseases. 

In addition, heat stress exacerbates cardiovascular and respiratory health complications, especially among vulnerable groups.

Exposing the fragility of health systems 

Government officials and relief workers wade through floodwater in Mozambique in February 2026.

Health systems are grappling with the most significant effects of climate change. Floods are damaging or rendering health facilities unusable, disrupting essential medicine supplies and breaking supply chains. 

Climate emergencies are widening service delivery gaps by increasing the workload of already overstretched health workers. More broadly, climate change is exposing the fragility of health systems designed for stability in an increasingly dynamic environment.

Many African health systems remain organized around vertical programs and short-term interventions. While these approaches have improved outcomes in specific disease areas, they are poorly suited to respond to climate-related shocks. As a result, these crises increase operational costs when core functions such as disease surveillance, emergency preparedness, infrastructure planning, and primary care are managed in silos.

Climate change increases fragmentation tax – the accrued cost of fragmented systems. In the case of climate-related emergencies, this fragmentation often translates into slower responses, preventable sicknesses, and the loss of trust by the population. 

Integration is fundamental to resilience and requires interoperable systems and governance structures that enable flexible service delivery models, allowing rapid adaptation to changing conditions.

Adaptation as an imperative

Workers in Sierra Leone install a solar panel at a health clinic.

Climate change adaptation is not a nice-to-have feature of health systems but an essential capability of health security. 

This implies a shift from the largely reactive emergency response approaches to anticipatory system design. Health systems that are climate-resilient incorporate climate risk in all their planning and investment decisions. 

This involves climate-proofed health infrastructure, enhancing early warning systems, responsive and adaptive supply chains, and providing health workers with the skills needed to address climate-sensitive health threats.

Crucially, it also requires aligning health policy with broader national adaptation strategies to ensure health is fully integrated into climate planning.

Africa’s leadership moment

Despite its vulnerability to climate risks, Africa is at the forefront in developing health models that are resilient and responsive in nature. Locally led initiatives are emerging across the continent, from community-based surveillance to climate-informed primary healthcare. These approaches show that adaptation is most effective when context-specific and nationally driven.

What is needed is scale, coordination, and political commitment. Climate adaptation must be integrated into health financing systems, regulatory frameworks, and regional collaboration mechanisms.

This is not only about protecting populations, but also about safeguarding economic stability, institutional credibility, and long-term development trajectories.

Climate change has introduced a new and increasingly fragile context for health service delivery and the process of reframing it as a health systems issue is at a critical juncture. 

It requires the health leaders to be front and centre in climate decision-making and climate resilience to become a performance indicator for health systems. This will also be a key issue at the upcoming WHS regional meeting hosted by the Aga Khan University in Nairobi from 27-29 April. 

Framing climate adaptation as a health systems strengthening pillar will help in shifting the discussion from awareness to implementation. Africa’s future depends on shifting from fragmented responses to coherent, self-reliant health systems. Our resilience in this age of disruption will be defined not by what we promise for tomorrow, but by what we do today.

Professor Anthony Ngugi is Associate Dean of Research at the Aga Khan University Medical College East Africa, in Kenya and chairperson of the programme committee of the World Health Summit regional meeting.

 

 

Image Credits: The Salvation Army, Bureau National de Gestion des Risques et des Catastrophes (BNGRC), WHO.

Dr Yap Boum, Africa CDC’s deputy incident manager.

Climate change is driving cholera cases in various African countries, particularly in  Mozambique, which was hit by two tropical cyclones earlier this year that caused widespread flooding, according to Dr Yap Boum of the Africa Centres for Disease Control and Prevention.

Meanwhile, two tropical cyclones in Madagascar resulted in the deaths of 600 people, the displacement of 180,000 others and the destruction of over 120,000 houses.

Madagascar is one of the countries worst-affected by cyclones in Africa, and the intensity of these is increasing with climate change.

Fourteen African countries have reported cholera outbreaks so far this year, with a total of 23,776 cases – and over 84% of cases are in Mozambique and the Democratic Republic of Congo (DRC).

Globally, 59% of cholera cases are in Africa, but 99% of deaths are on the continent, where the case fatality rate is over 2%. The Africa CDC aims to halve this.

Southern Africa has been particularly badly affected, with a seven-fold increase in cholera cases in the first six weeks of 2026 in comparison to the same time last year, according to the World Health Organization (WHO) Africa region. This has been driven largely by cases in Mozambique and Angola.

Dr Marie Roseline Belizaire, WHO Africa’s emergencies director, told a recent media briefing that “the sharp rise in cholera cases in Southern Africa is a clear reminder of how climate-related shocks are intensifying public health risks”.

The cyclone-related floods in Mozambique killed 270 people and displaced over 370,000 others. 

“This flooding has the impact first on waterborne diseases, including cholera… and also vector-borne diseases, including malaria and dengue, because the flood water provides breeding sites for mosquitoes,” Boum told a media briefing on Thursday.

Angola has had two waves of cholera, said Boum. However, 54% of the population lacks access to safe drinking water, and only about 55% have adequate sanitation, he noted. 

“Although we can manage to stop the [cholera] wave, it will come back until people have proper access to water and sanitation.”

There have been new cholera outbreaks in Rwanda and in Zimbabwe, with Zimbabwe recording a 3.2% case fatality rate, the highest rate on the continent.

Meanwhile, southern Ethiopia experienced heavy rain last week that resulted in a mudslide and flooding that killed 125 people and displaced at least 10,000 others.

 

SAGE chairperson ​​Professor Anthony Scott announcing new recommendations on Typhoid, Polio and COVID. 

Countries with a high incidence of typhoid or antimicrobial resistance to its leading pathogen, Salmonella Typhi, should introduce typhoid vaccinations, according to the World Health Organization’s (WHO) Strategic Advisory Group of Experts (SAGE) on Immunization.

In new guidance issued Wednesday, SAGE also recommended routine COVID-19 vaccination for groups at highest risk of severe COVID-19 disease every six months and reducing polio vaccines from three to two doses in countries at low risk.

SAGE, which meets every quarter, spent last week considering global reports on emerging disease challenges and setting priorities in a context where countries are facing “uncertain funding, competing priorities and eroding public trust”, said chair ​​Professor Anthony Scott.

“Typhoid fever is estimated to cause about six million cases and 72,000 deaths worldwide,” said Scott, who is professor of vaccine epidemiology at the London School of Hygiene and Tropical Medicine.

“Children between five and nine years of age are most likely to have laboratory-confirmed typhoid fever and thus carry the largest share of cases,” said Scott, adding that protection from a single dose of typhoid conjugate vaccine (TCV) can decrease over time, particularly in children under two.

SAGE is thus also recommending a booster dose for children aged around five years of age in very high typhoid incidence settings.

SAGE first recommended rolling out the TCV in 2018, said Scott, so many high incidence countries have “already either implemented or have set in train the process of implementing the vaccine”.

In Southeast Asia, Pakistan, Nepal, Bangladesh and India are considering the vaccine. In Africa, Zimbabwe, Kenya and Niger, are also considering the vaccine, said Scott.

However, he warned that “the epidemiology of the disease varies quite widely, even within country, and it’s a particularly difficult disease to characterise and diagnose.”

COVID-19 vaccines for vulnerable groups

Dr Kate O’Brien, head of the WHO’s Department of Immunization, Vaccines and Biologicals.

“While the global burden of severe COVID-19 has declined worldwide thanks to broad immunity, both from vaccine and past infection, the virus continues to cause significant illness and death,” said Scott.

SAGE recommends COVID-19 vaccination every six months for groups at highest risk of severe disease – the elderly, older adults with significant comorbidities or severe obesity, residents in care homes and and moderately or severely immunocompromised individuals. 

SAGE also recommends one dose for pregnant women, ideally during the second trimester.

However, Dr Kate O’Brien, head of the WHO’s Department of Immunization, Vaccines and Biologicals, acknowledged that country support from the vaccine platform, Gavi, to buy COVID-19 vaccines had ended last year which would impact on the availability of these vaccines.

Dr Annelies Wilder-Smith, WHO Vaccine Policy Team Lead and SAGE Executive Secretary, added that while the current COVID-19 vaccines prevented severe disease, the weakness was that they did not prevent transmission.

“To reduce transmission, we would really like to see vaccines that have an impact on mucosal immunity,” said Wilder-Smith.

Dr Annelies Wilder-Smith, WHO Vaccine Policy Team Lead and SAGE Executive Secretary

Reduction in polio doses

Wild polio virus transmission remains endemic in only two countries, Pakistan and Afghanistan. 

“SAGE is deeply concerned about the continued transmission of wild polio virus type one in both of these countries, as well as disruptions that are hindering the shipment and laboratory testing of stool and environmental samples from Afghanistan,” said Scott.

Circulating vaccine-derived polio virus type two had also been detected in “several African countries”, including northern Nigeria and Somalia.

“There’s an urgent need to strengthen routine immunisation and reach zero dose children, to curb circulating vaccine-derived polio virus type two transmission,” Scott stressed.

But in countries at low risk of polio, it is possible to reduce the number of bivalent polio doses from three to two, “provided this combined schedule will sustain mucosal immunity”.

Administering a polio vaccination – low risk countries could reduce doses from 3 to 2. SAGE says

Acute resource reductions

O’Brien acknowledged the current context of conflicts, and economic challenges, resulting in  national health budgets being reduced.

The challenge for countries’ National Technical Advisory Groups on vaccines is to ensure that they have the surveillance systems to know where diseases occur and where the target should be, she said.

“The focus of 2026 and onward is to protect the core of the core of immunisation programmes and to integrate the efforts across different initiatives and for countries to make decisions on where they will focus the resources,” said O’Brian.

However, she noted that the WHO recommended vaccinations for 14 diseases, and over 80% of countries cover 10 or more of those diseases.

“This has been an incredible success story that has allowed for health impact and health gains to be made, including the reduction of infant mortality. But we’re entering a very challenging phase, and countries will need to make increasing decisions on optimization of their vaccine schedules,” she warned.

Image Credits: Pakistan Polio Eradication Program .

Garry Aslanyan, Catherine Kyobutungi and Ricardo Baptista Leite
Garry Aslanyan, Catherine Kyobutungi and Ricardo Baptista Leite

Global health is facing a crisis not only in funding, leadership, and trust, but also in information integrity, according to speakers on the first episode of The Inside Track, a new series from the Global Health Matters podcast.

Host Garry Aslanyan was joined by Catherine Kyobutungi and Ricardo Baptista Leite for a conversation on how misinformation spreads, why trust in science has eroded, and what health leaders can do to push back.

Kyobutungi said the problem has grown alongside an expanding information economy, where sensationalism often travels faster than facts. Scientists, she argued, have not adapted quickly enough to a landscape shaped by influencers, closed online communities and monetised content.

“The biggest, maybe the most colossal failure that … the global health community had was a failure of communication,” she said, pointing to the COVID-19 pandemic and the inability to clearly explain concepts such as risk to the public.

Baptista Leite warned that the issue goes beyond disagreement. In many cases, he said, people are no longer arguing over the same set of facts.

“If someone comes along and says, No, it’s not a chair, it’s a horse,” he said, “then the conversation becomes impossible.”

Still, both speakers said the answer is not retreat. Kyobutungi urged scientists and global health professionals to return to the public square, speak more clearly and engage not only with those spreading falsehoods, but also with the wider audience watching from the sidelines.

Later in the episode, the panel turned to a recent article on the spread of chikungunya in Europe, using it as an example of how climate warnings often fail to produce meaningful action. The discussion closed on a more hopeful note, highlighting promising work in artificial intelligence and a new Africa-led HIV vaccine trial.

For Kyobutungi, the battle is not lost. But the momentum, she suggested, must still be won back.

Listen to the full conversation >>

Read more about Global Health Matters podcasts on Health Policy Watch >>

Image Credits: Global Health Matters Podcast.

Prof Ntobeko Ntusi and Dr Garry Aslanyan
Prof Ntobeko Ntusi and Dr Garry Aslanyan

South Africa and the African continent must play a far greater role in shaping the future of global health, according to Ntobeko Ntusi, president and CEO of the South African Medical Research Council.

Speaking during a Trailblazers episode of the Global Health Matters podcast with Dr Garry Aslanyan, Ntusi said his world-view was shaped first by his parents, then by teachers and mentors, and later by his experience treating patients with HIV at a time when treatment was not yet available in South Africa.

He said watching patients die during those years fuelled “a desire to have universal access and universal healthcare, but also a desire to ensure equity in all aspects of health and science.”

Ntusi said successful science councils must do more than fund research. They must explain the value of science to society, help governments understand why health research matters and align their work with national priorities.

In South Africa, he said, that means focusing on the country’s “quadruple burden of disease,” including HIV and tuberculosis, non-communicable diseases, mental health, violence, trauma, and maternal and child health. He said the council is also prioritising climate and health, digital health and AI, antimicrobial resistance, pandemic preparedness and universal health coverage.

Ntusi said violence remains one of South Africa’s deepest challenges and cannot be treated as a health issue alone. “These are not just health issues,” he said. “They are societal issues, and they need a whole of government and a whole of society.”

He also called for a major shift in how the world thinks about global health. Ntusi said he prefers the term “global majority” over Global South, noting that 85% of the world’s population lives in low- and middle-income countries.

“The first acknowledgement is that global health is failing in measures of equity by whatever measure one uses,” he said.

For Ntusi, leadership starts with clarity. The most important quality a leader can have, he said, is “self-awareness.”

Listen to the full episode >>

Read more about Global Health Matters episodes on Health Policy Watch>>

Image Credits: Global Health Matters.

A doctor and her young patient. The American Academy of Pediatrics is opposing changes to the US childhood vaccination schedule.

A United States judge has temporarily halted US Health Secretary Robert F Kennedy Jr’s anti-vaccine agenda, ruling on Monday that Kennedy’s firing of the country’s vaccine advisory committee and changes to childhood vaccinations were likely illegal.

US District Judge Brian Murphy ruled that the January changes to the vaccination schedule and Kennedy’s firing of all 17 members of the Advisory Committee on Immunization Practices (ACIP) are likely to have violated the Administrative Procedure Act. 

Murphy has issued three temporary stays – on the changes to the vaccination schedule, the appointment of 13 ACIP members and all decisions of the Kennedy-appointed ACIP. These stays will be in place until Murphy can rule on a lawsuit brought by the American Academy of Pediatrics (AAP) and other medical organisations against Kennedy’s “unilateral changes” to vaccinations for children and pregnant women.

“Faced with plaintiffs’ motion for preliminary relief, the court concludes that plaintiffs are likely to succeed in showing that the reconstitution of ACIP and the January 2026 changes to the childhood immunization schedule violate the Administrative Procedure Act,” Murphy ruled.

Reacting to the ruling, AAP president Dr Andrew Racine said on Monday evening that it “effectively means that a science-based process for developing immunization recommendations is not to be trifled with and represents a critical step to restoring scientific decision-making to federal vaccine policy that has kept children healthy for years.” 

The AAP represents over 67,000 paediatricians throughout the US.

Dr Jason Goldman, president of the American College of Physicians, described the ruling as “a win for public health and reaffirms that national vaccine policy should be guided by rigorous, evidence-based science, not politics.”

Dr Georges Benjamin, president of the American Public Health Association, said that “trust occurs when we engage the public in a transparent process, not one where decisions are made behind closed doors by unqualified individuals and presented in a disingenuous way.” 

Seven professional bodies are co-plaintiffs in the case against Kennedy, including the American College of Physicians, American Public Health Association, Infectious Diseases Society of America, the Massachusetts Public Health Alliance, and the Society for Maternal-Fetal Medicine. Three unnamed pregnant women are also plaintiffs.

Appointment of ‘vaccine skeptics’

The AAP case focused initially on changes in recommendations for COVID-19 vaccines but was later extended to oppose the changed schedule for childhood vaccines, after the US Health and Human Services (HHS) reduced the number of recommended vaccines from 17 to 11. 

The AAP argues that the HHS arbitrarily and illegally overhauled the Centers for Disease Control and Prevention (CDC) vaccination schedule “without following the evidentiary-driven, and legally required processes.”

It also argues that Kennedy and the HHS have failed to “examine the relevant data and articulate a satisfactory explanation” for:

  • the appointment of vaccine skeptics to ACIP after all previous members were fired;
  • votes taken by ACIP changing recommendations on the hepatitis B and COVID-19 vaccines and urging manufacturers to stop using thimerosal as a preservative in influenza vaccines;
  • the alteration of the immunization schedule, which no longer recommends shots for hepatitis A and B, rotavirus, respiratory syncytial virus, flu and meningococcal disease for all infants; and
  • the removal of the CDC’s routine recommendation for healthy children and pregnant women to receive the COVID-19 vaccine.

Memos released by HHS in response to AAP’s lawsuit show that the department based its decision to restrict COVID-19 vaccines on scanty reports that lacked scientific evidence, according to weekend reports

“The memos overlooked hundreds of studies on the benefits and safety of COVID vaccination and set the precedent for making changes to vaccine recommendations based on ideology instead of evidence,” the Guardian reported.

Data from the US CDC itself, based on COVID-19 vaccination of more than a million pregnant women, found that the vaccine “did not increase health risks for pregnant women or their babies” and “the benefits of receiving a COVID-19 vaccine outweigh potential risks”.

The studies showed “no increased risk for complications like miscarriage, preterm delivery, stillbirth, or birth defects”, while COVID-19 infection could cause stillbirths, preterm delivery and hospitalisation of babies.

ACIP meeting stopped

The ACIP meeting scheduled for later this week will no longer go ahead. One of its agenda items was on COVID-19 vaccine injuries, with speculation that the committee is preparing to discontinue COVID-19 mRNA vaccines altogether.

ACIP vice-chair and vaccine sceptic Robert Malone described Murphy’s decision as “activist judicial intervention” in a lengthy Substack post devoted mainly to defending his qualifications.

However, Kennedy’s anti-vaccine agenda is polling badly with the US public, according to Republican polling company Fabrizio Ward.

An extract from the Fabrizio Ward poll on vaccines.

In a report issued last December, Fabrizio Ward reported that its polling showed “strong bipartisan support for routine childhood vaccines in the nation’s most competitive House districts, with majorities across political affiliations acknowledging their benefits and safety” – including with voters in Kennedy’s Make America Health Again (MAHA) camp.

“While the MAHA agenda is broadly popular in the area food and agriculture, vaccine skepticism stands as an outlier, rejected by most voters even within the MAHA movement,” the company notes.

Image Credits: American Academy of Pediatrics, Fabrizio Ward.

A black carbon monitoring station at a glacier in Nepal has recorded the effects of black carbon on melting ice.

BANGKOK – The combination of heat and “super pollutants” is emerging as a critical threat to human health, according to experts at the Better Air Quality (BAQ) conference which ended last Friday in Bangkok.

Short-lived super pollutants – methane, black carbon, hydrofluorocarbons (HFCs), nitrous oxide and ground-level ozone – contribute to half of global warming and millions of premature deaths. 

These pollutants have a short life span, but some can be transported thousands of kilometres in days.  Meanwhile, rising heat and humidity can create dangerously high heat stress temperatures and worsen the impact of breathing polluted air. 

“From a biological pathway perspective, one hypothesis is that heat stress may increase susceptibility to the respiratory toxicity of PM2.5 (a fine particulate matter pollutant), potentially through airway dehydration, epithelial irritation, and enhanced inflammatory responses,” Steve HL Yim, a professor of environmental health at Singapore’s Nanyang Technological University, told Health Policy Watch.

Long-term exposure to black carbon already heightens the risk of cancers such as lung adenocarcinoma, commonly seen in non-smokers. Short-term exposure to black carbon may exacerbate asthma and Chronic Obstructive Pulmonary Disease (COPD or chronic lung disease), while short-term exposure to ozone may result in lung function damage.

Yim’s research shows how a global increase of just 0.1 microgram/cubic metre in black carbon (soot) concentration is associated with a 12% increase in the incidence of lung adenocarcinoma, a type of lung cancer usually associated with air pollution.

Risk for Global South

The combination of super pollutants and heat are on the rise in many parts of the world, especially in the Global South where tropical and developing nations are struggling to balance climate change adaptation while pursuing rapid development.

“The situation in Southeast Asia, South Asia and Africa is worse compared with North America and Europe,” said Yim, who is an expert member of the World Health Organisation’s (WHO) Global Air Pollution and Health Technical Advisory Group.

The risk is threefold, Yim explained. First, the emissions in the three regions are high. Second, the latest technologies take time to be transferred to the three regions. Third, there is no regulation or standard, measurement network in the three regions. 

Trans-boundary air pollution in South East Asia already causes health problems, and hot weather in these regions could create a “synergistic health effect… (that is) very serious”.

Professor Steve Yim from Singapore’s Nanyang Technological University

The sources of super pollutants are all around us. Black carbon comes from burning biomass and fossil fuels; methane from waste, cattle, agriculture, and industry; ozone indirectly from vehicles thanks to a chemical reaction between heat and vehicular exhaust; and HFCs from sectors such as refrigeration and air conditioning.

Tackling these pollutants can be highly effective, according to Jane Burston, CEO of the Clean Air Fund, a global philanthropy. 

“Half of the global warming that we have experienced to date is because of super pollutants,” said Burston.

“Because they don’t spend very long in the atmosphere, the quicker we can reduce them, the quicker this will impact climate change, which is why they’ve come to be known as the emergency brake on climate change.”

Burston says preventing super-pollutants could potentially avoid more than half a degree of warming by 2050 and prevent millions of premature deaths. Air pollution was linked to over eight million deaths in 2021. 

Convincing governments to act

Development and funding agencies spoke candidly, calling on governments to step up national action and regional cooperation, which can be hard given the tension between several neighbours. 

Patrick Bueker, senior technical advisor at the German Society for International Cooperation (GIZ), called for a “carrot-and-stick approach” for policymakers. The “carrot” involves demonstrating the benefits of regional co-operation in Southeast Asia, such as sharing best practices and data. Bueker suggested a new regional declaration, building on the existing Association of Southeast Asian Nations (ASEAN) agreement on transboundary haze.

The “stick” requires citizens to “push policymakers into acting on air pollution. We haven’t seen any improvement in the region,” Bueker said. 

While the effects of particulate matter (PM2.5) is well known, there is less awareness of ozone, which affects health and agricultural productivity. An informed public can “push policymakers to action”. 

From left: Clyde Hutchinson (ADB-Korea Climate Technology Hub), Patrick Bueker (GIZ) and Parth Sarathi Mahapatra (ICIMOD) with  Jane Burston, Clean Air Fund CEO (right).

Citizen science vital for air pollution

Clyde Hutchinson of the Asian Development Bank (ADB) identifies citizen science as a major opportunity, emphasising this as key to shared responsibilities: “Technology is accessible and cheap, (air pollution) sensors are cheap. We can do everything on our phone; all of us can be climate scientists now.”

Hutchinson says his role as a technology specialist of the ADB-Korea Climate Technology Hub is to “match-make” funding and technology with policy action. 

“There’s no challenge with technology or funding. So what is going wrong here? 
Why can’t we get these programs underway? And that’s part of my job. How do we match both the funding and the technology?” asked Hutchinson.

Complicated regional dynamics

The impact of open and biomass burning and fossil fuel combustion, mainly in India and Nepal, has already accelerated the melting of Himalayan glaciers. A pollution monitoring station on a Nepalese glacier at approximately 5,000 metres above sea level captured proof of this, and the culprit is black carbon.

The Indo-Gangetic Plain-Himalayan Foothills region is one of the largest, most polluted airsheds in the world, and is also in a politically sensitive neighbourhood. A key agency, the International Centre for Integrated Mountain Development (ICIMOD), working on air quality, has a difficult task as two of its member, Pakistan and Afghanistan, are engaged in conflict. 

Political co-operation remains unlikely even though ICIMOD has shepherded an air quality agreement – the Thimphu Outcome. Separately, the World Bank is providing hundreds of millions of dollars as loans across the countries. 

Despite the tensions, ICIMOD representative Parth Sarathi Mahapatra says countries “could come together voluntarily to form a cooperation platform.” 

Mahapatra, an air pollution mitigation specialist, says scientific evidence as provided from the Himalayan glacier and customising solutions from a local to the national level could encourage South Asian policy makers to act on super pollutants. Black carbon alone is affecting the richest source of freshwater, after the poles, for millions of people downstream from the glaciers. 

Against rising heat, government action can no longer afford to proceed at a glacial pace.

Image Credits: Nanyang Technological University, Chetan Bhattacharji.

Chula Pop Bus’ is an electrically powered bus servicing students and staff of Chulalongkorn University in Bangkok.

The 12th Better Air Quality conference opened with a call to treat clean air as vital economic infrastructure, highlighting the large benefit-cost return – but financing clean-tech is a challenge in developing nations.

BANGKOK – Short-term impacts of bad air quality don’t just cause high economic costs but also lead to children scoring poorly in tests, warned a World Bank senior official at the opening of the Better Air Quality (BAQ) conference on Wednesday. 

The option to invest in cleaner air results in healthier people and stronger economies. Failure to do so means countries will continue to bear the costs of pollution –  in hospitals, in lost productivity, and in weakened economies, says Bindu Lohani, chair of Clean Air Asia, BAQ’s main organiser. 

A significant concern for the BAQ conference is how to increase financing for clean air action. It costs about 0.1% of regional GDP annually to roll out the most effective measures, a World Bank report estimates, while the benefit-cost ratio can be more than 9:1 for countries like Pakistan, India and Bangladesh.

Lohani called on governments to treat clean air as core economic infrastructure and set targets to achieve the net-zero climate target by 2050.

By 2030, governments should significantly reduce urban particulate pollution, electrify transport systems, expand monitoring, and eliminate the most polluting fuels and practices, such as agricultural and open burning, Lohani proposed. By 2040, air quality should be fully aligned with climate policy and on a path to achieve the 2050 target. 

The World Bank’s Ann Jeanette Glauber acknowledged that tools such as emissions inventories and enforcement capacity are “essential public goods, but they aren’t sexy”. 

“There’s no ribbon cutting. Often, they don’t make money, necessarily,” Glauber said, adding that the most financially viable solution is to focus on industry.

“For us in South and Southeast Asia, the main sources of emissions are industries.  And these need clean tech boilers, furnaces, kilns and pollution control devices,” she said, adding that there were limited resources to roll these out.

Tussle over clean-tech finance

Reena Gupta (centre, with microphone), chairperson of the Punjab Pollution Control Board

Reena Gupta, chairperson of the Punjab Pollution Control Board, said there is very little money flowing into developing countries to assist with air pollution.

Citing the clean tech projects presented at her panel discussion, Gupta said that while they are excellent, they are “only pilots”. 

In Punjab in north India, most furnaces in a town known for metal recycling are still being run on coal:  “We know the clean technology exists. But it is not viable for the recycling businesses,” she said.

Gupta proposed that the international finance agencies develop mechanisms to cover risk for businesses to change to cleaner technology for the first couple of years, after which costs can be borne by the business. 

In contrast, the World Bank’s Glauber suggested that affected countries should first leverage things like their finance policies, “then investment flows…  It’s really about helping commercial finance go into those actual technologies, and you’re basically pushing them over that cost barrier so that they become financially viable.”

Citing Nepal’s example, Glauber said that the government made it far cheaper to import electric than fossil fuel vehicles. It is now one of the fastest electric vehicle markets in the world, and has the second highest electric vehicle only to Norway, in terms of electric vehicle penetration.

“You play with those [policy] levers, and then investment flows. Obviously, lots to be done in risk-sharing mechanisms that crowd-in private finance for industrial pollution control technology. That’s where the magic needs to happen,” Glauber said.

Ann Jeannette Glauber, from the World Bank’s Environment Department (South Asia).

‘Exporting air pollution’

Wealthier nations are also offloading their obsolete and polluting products in the region.

“We have had to shut down a few tyre pyrolysis units (in Punjab) that were not deploying proper air pollution control devices. Latest reports have shown that waste tyres are being sent to India from the UK and the Middle East. This is becoming a big source of black carbon, a super pollutant,” she told Health Policy Watch.

A study by philanthropic organisation Clean Air Fund (CAF) shows that measures to prevent air pollution are massively underfunded and funding does not reach populations with the highest exposure. 

Despite the 9:1 benefit-cost advantage, and despite studies that put premature deaths because of air pollution at 8.1 million in 2021, air quality solutions receive 1% of international development funding, according to CAF. This too saw a 20% decrease between 2022 and 2023. 

Bangkok is turning the tide on air pollution

The BAQ was last held in Bangkok 18 years ago. City officials say much has changed since then. Along with the economy and skyline growing, air pollution is a “visible” problem. 

“On the worst days, parents keep their children indoors, hospitals fill with patients, and the residents lose their trust that the government is doing anything at all,” says PornphromVikitsreth Techapaiboon, chief sustainability officer of the Bangkok Metropolitan Administration, speaking at the opening session. 

But there have been measurable improvements in the last year in reducing PM2.5 pollution, he added. The number of “orange and red’ (poor air quality) days has almost halved since 2015 and the PM2.5 concentration fell from nearly 50 micrograms per cubic metre to 37.6, a 22% decrease. 

These, he says, are “genuine turning points” and that “PM2.5-related patients have decreased in January.”

The causes of air pollution are unfavourable geography (Bangkok is in a basin), vehicular, especially diesel pollution, and biomass burning, as shown by their “dust detective” teams with experts from academia and civil society organisations. 

This has led Bangkok to create an air quality strategy, declaring itself last year to be a pollution control zone. This includes working with upwind provinces where biomass is burnt, leading to more burn-free days. It introduced a ‘green list’ for heavy trucks that are banned from Bangkok unless they can show evidence of recent maintenance. Industrial monitoring is being ramped up.

A portable air quality monitor on display at BAQ 2026 in Bangkok

Pornphrom says they’re investing in green spaces, not just for aesthetics, but as a public health intervention. PM2.5 levels inside parks are 33-43% lower than in surrounding areas. They message seven-day PM2.5 forecasts and are installing ‘clean air rooms’ in schools. 

Thailand is emerging as a test case for integrated air quality and climate investment, the conference heard. The Asian Development Bank (ADB) presented a proposed Thailand Integrated Air Quality Investment Program. 

The proposal outlines a 10-year investment platform aligned with Thailand’s PM2.5 Action Plan and forthcoming Clean Air Act, designed to bring together multiple sectors under a single framework.Priority areas include transport electrification, crop residue management, renewable energy expansion and industrial emission standards.

The ADB referenced a programme in Beijing–Tianjin–Hebei in China, where coordinated action across sectors, including fuel switching, clean heating, and industrial upgrading, helped reduce PM2.5 levels by around 40% compared to 2015.

At the city level, Bangkok also highlighted the need for sustained partnerships.

“Air pollution is a complex challenge that no single city can solve alone. Sustainable air quality improvement requires long-term investment and strong international collaboration,” said Pornthep.

Image Credits: UN Thailand, Chetan Bhattacharji.