Dr Tedros (centre) welcomes the restrictions on digital marketing of breastfeeding substitutes in Committee A.

The World Health Assembly has finally closed a loophole used by infant formula manufacturers to market their product: digital marketing.

Back in 1981, when the International code of marketing of breast-milk substitutes was adopted by the World Health Organization (WHO) and UNICEF, digital marketing did not exist. Updated regulations were introduced in 2012 , but this too was before the widespread targeting of consumers via social media platforms and their targeted algorithms. 

The World Health Assembly approved a resolution on Monday that gives member states the opportunity to get technical support from the WHO on how to implement its guidance on “regulatory measures aimed at restricting digital marketing of breast-milk substitutes”.

The resolution, put forward by Brazil and Mexico, also calls on the WHO Director-General to compile country lessons and challenges in implementing the guidance, and report back on progress in 2028.

“This resolution will help us to push back” against those promoting breastmilk substitutes, Director General Dr Tedros Adhanom Ghebreyesus told delegates in Committee A after they had passed the resolution.

Dr Bruce Aylward, WHO Deputy DG for Universal Health Coverage, added that the WHO was working with partners “to develop artificial intelligence tools that will help you identify violations against national laws to help with the enforcement”.

Global sales of formula milk were estimated to reach $164.76 billion in 2024.

Mothers interviewed by  a multi-country study. reported being “targeted by online marketing and being inundated by marketing for formula milk including promotions prompted by their search behaviour for infant feeding advice and information”.

In addition, a “suite of alternative formulas presents formula milk products as satisfying all possible needs”. 

The committee also resolved to incorporate the World Prematurity Day into the WHO calendar during the discussion on 

Some 13.4 million babies are born preterm, and preterm birth complications are the leading cause of death amongst children under the age of five, according to the resolution.

“With extremely pre-term children, the probability of death in a low income country is over 90% in the first few days of life, and it’s less than 10% in high income countries,” said Aylward.

Sexual and reproductive rights

The resolutions were adopted as part of a discussion on the Global strategy for Women’s, Children’s and Adolescents’ Health, tabled at the WHO executive board. 

The report highlights that countries are off track to reach the targets of the Sustainable Development Goals (SDG) related to maternal, newborn and child mortality by 2030. 

The maternal mortality rate is only expected to drop to 176 deaths per 100,000 live births whereas the SDG target is 70 deaths per 100,000 live births, said Tedros.

“The 60 countries who are not on target, should accelerate. I think focus on the 60 countries will be very, very important. There are proven tools to make that happen.

“But the concern that we have is that, in many countries, investment is declining, especially in maternal health and child health, so our call is to reverse that,” he added.

Poland, speaking for the EU, pushed for a rights-based approach to sexual and reproductive health.

Poland, on behalf of the European Union and nine candidate member countries, spoke about the need for sexual and reproductive health to have a human rights approach

“The EU reaffirms its commitment to the promotion, protection and fulfilment of the right of every individual to have full control over and decide freely and responsibly on matters related to the sexuality and sexual reproductive health, free from discrimination, coercion and violence,” said Poland. 

“The EU further stresses the need for universal access to quality and affordable comprehensive sexual and reproductive health information education, including comprehensive sexuality education and healthcare services.”

Finland, speaking for its Scandinavian neighbours and several surrounding countries, explicitly articulated that women should have access to safe abortion.

This sentiment was echoed by Germany, which stated: “We are concerned about the growing health disparities, and must ensure a human rights-based approach to health with gender equality and equity at the centre, whilst addressing gender-based and age-related violence. Access to comprehensive SRHR services, including modern contraception, safe abortion and post abortion care and comprehensive sexuality education are essential.”

There was no pushback from countries that would usually object to references to abortion, and the the committee session passed without disagreement.

 

Hungry children wait in line at a soup kitchen in northern Gaza in May.

Vital medical aid from World Health Organization supply trucks has yet to reach the beseiged Gaza enclave since the doors of an 80-day blockade inched open a week ago, said Hanan Balkhy, WHO’s director for the Eastern Mediterranean Region, at a UN-Geneva press briefing on Monday.

The chaos on the ground in Gaza, against a widening Israeli war and a halting resumption of some humanitarian aid deliveries, contrasted sharply with the largely symbolic vote by the World Health Assembly on Monday authorizing WHO to “raise the flag” of Palestine along that of other WHO member states.

The decision to ‘raise the flag’, approved by a vote of 95-4, was the fourth measure on the status of Palestine and the crisis in Gaza to come before the WHA in its 2025 session.  Only the Czech Republic, Germany, Hungary and Israel  voted against the measure, while 27 member states abstained.

“The WHA’s endorsement of this decision would … send an important message to Palestinians that they have not been forsaken. It would demonstrate that the Palestinians right to self determination is inalienable, and as such, cannot be subject to a veto, nor erased,” said South Africa’s delegate, during the WHA debate.

Eastern Mediterranean Regional Director Hanan Balkhy at a UN-Geneva press conference on Monday.

On the ground in Gaza, meanwhile, no WHO trucks of medical supplies have so far been allowed entry to  the beseiged enclave since Israel first began to allow some aid deliveries to resume last week, easing an 80-day blockade. Balkhy said 51 WHO trucks were poised and waiting to enter from Egypt’s El Arish crossing point.

As of Friday, while 415 humanitarian aid trucks had been cleared to cross into Gaza, only 115 had been “collected”, and none had been allowed to enter the northern part of the enclave, which is seeing the heaviest fighting now, she added, quoting a Friday briefing by the UN Secretary General, Antonio Guterres.

The UN numbers corresponded roughly with those of Israel’s military coordination arm, COGAT, which reports that 388 trucks entered the enclave since the beginning of May. But many trucks have also been overhwlemed by hungry Gazans before UN aid agencies could collect and deliver the aid in a more systematic aid. See related story:

WHO Director General Appeals to Israel to End Deepening Food Crisis and Conflict in Gaza

Balkhy said that 43% of essential medicines are at “zero-stock” levels in addition to 64% of medical supplies and 42% of vaccines, citing data from Gaza’s Hamas-controlled Ministry of Health. Patients with chronic and life-threatening conditions—including kidney failure, cancer, blood disorders, and cardiovascular disease—are among the most affected, she added, saying, “WHO’s stocks in Gaza are dangerously low and will run out soon,” citing problems with dozens of products from common antibiotics to cesarean delivery kits.

Since 2 March, 57 children have reportedly died from the effects of malnutrition, Balkhy added, also citing Gaza Ministry of Health data. And 71 000 children under the age of five are expected to suffer from acute malnourishment over the next eleven months, if conditions don’t change radically.

Delays in mounting of private Gaza humanitarian aid effort

Her comments came against a day in which Israel’s planned opening of private aid distribution points for Gaza aid, intended to sidestep UN agencies and Hamas, was reportedly delayed for a second time.

That followed Sunday’s resignation of the Jake Wood, head the Gaza Humanitarian Foundation, the private entity that had been awarded a tender by Israel to deliver the aid, with US approval.

In a statement distributed by the Foundation, Wood was quoted saying that plans for the distribution hubs would not meet the “humanitarian principles of humanity, neutrality, impartiality and independence, which I will not abandon.”

Various UN organizations have also declared that they won’t cooperate with the Geneva-based GHF, which had earlier said it would distribute some 300 million meals in its first 90 days of operation. In an interview with CNN,  UNICEF’s James Elder described the plan as “unworkable” – with only a “handful” of distribution points.

“Think about a mom who has a couple of children and her husband has been killed.  And she has to walk three or four miles in a militarized zone to pick up aid and then walk back,” Elder said. He noted that the plan would also force most Gazan’s to relocate to the southern part of the tiny enclave to access any aid at all.

In a WHA meeting last week, WHO’s Health Emergencies Executive Director Mike Ryan had asserted that “we will work with anything that works” – but added that the UN agencies already had a proven track record of aid delivery – demonstrated during the last ceasefire.

Sudan is another, ignored, flashpoint

Another devastating crisis that is not getting the attention it deserves is Sudan, Balkhy asserted in her meeting with UN journalists Monday.

“Simultaneous outbreaks—cholera, polio, measles, dengue, malaria—are overwhelming a health system shattered by conflict. Access to care is vanishing, as violence displaces millions and blocks life-saving aid. Hunger and malnutrition affect 25 million—including 770,000 children facing severe acute malnutrition this year. Immunization rates have plunged to below 50 per cent, from 85 per cent before the war,” the EMRO Regional Director said.

“Attacks on health and vital infrastructure are rampant,” she said noting that drones have also hit Port Sudan and other aid entry points.

Throughout the conflict,  WHO has delivered over 2,500 metric tonnes of supplies, and supported hospitals treating over 1 million people, including ,75,000 children for severe acute malnutrition. Some 30 million people have received vaccines for cholera, measles, or polio. And in November 2024, Sudan introducted the malaria vaccine, reaching 35,000 children so far.

“But aid cuts are threatening progress,” she added. “The health pillar of Sudan’s Humanitarian Response Plan is just 9.7 per cent funded. WHO’s response has a 67 per cent funding gap,” she pointed out, calling for “sustained support to save lives and rebuild Sudan’s health system; unimpeded access and international support for cross-border humanitarian operations; and an immediate end to attacks on civilians, civilian infrastructure and health care.”

Image Credits: WHO .

Committee A adopted a resolution on strengthening the health workforce

Several countries at the World Health Assembly (WHA) called for enforcement clauses to be included in the World Health Organization’s (WHO) code on international recruitment as wealthier countries continue to recruit health workers from poorer countries.

Regions will take up discussion on how to strengthen the code, based on an expert advisory group’s assessment, and their suggestions will be tabled at next year’s WHA, delegates at the current WHA resolved on Monday (26 May).

Countries also passed a resolution aimed at accelerating action on the global health and care workforce.

The resolution requests the WHO Director-General to prioritize resources to support policy development and implementation of the health and care workforce priorities outlined in the Global Strategy on Human Resources for Health: Workforce 2030.

This includes fostering regional and global collaboration, and supporting member states to manage and develop their health and care workforce.

By 2030, there will be a global shortage of 11.1 million health workers and there is fierce competition for doctors and nurses in particular.

South-South collaboration

Small island developing states (SIDS) and African countries were outspoken about their battles to retain health workers.

Jamaica, Samoa and Barbados  all spoke of struggling to retain staff despite improving pay, working conditions and training, owing to “aggressive recruitment” of their health workers.

Jamaica said that “South-South collaboration” has been the only successful strategy to address the shortage of specialist nurses.

“Jamaica extends its appreciation to our long standing partner, Cuba, we engaged partners such as Nigeria and new partners, the Philippines and India,” the country noted.

Through collaboration with the Pan American Health Organisation (PAHO), Jamaica is developing a human resource for health policy and action plan and conducting a health labour market analysis. It should be noted that the latter is the first for the English speaking Caribbean. 

“The ongoing migration of our health care workers poses a serious threat to our health system. We urge the WHO and international partners to amplify advocacy on its impact in SIDS like Jamaica, and to actively promote fairer, more ethical recruitment by high income countries.”

Barbados called for a “binding framework to protect health worker rights and align migration with national priorities”.

Africa faces ‘critical challenges’

Ghana, speaking for Africa, said that the region “continues to face critical health workforce challenges, including acute shortages, gender inequities, skill imbalances and the maldistribution of personnel”. 

These issues have been exacerbated by migration, limited funds and “fragile working conditions”.

“The evolving healthforce migration requires that Western countries that demand Africans must contribute to the training of more workforce,” said Ghana.

Sudan reported that the conflict has had a “devastating impact on the already strained health workforce sector, where a sizable number of health workers have left the country or displaced internally due to the security situation. Those who remain in the front line are subjected to major risks, strain and work overload.”

Meanwhile, the small country of Eswatini acknowledged that it was unable to employ 10% of its health workforce because of financial constraints.

Zimbabwe endorses a “global solidarity fund to help mitigate the impact of health work in immigration in low and middle income countries”.

Community health workers

Thailand for South-East Asian Region (SEARO) reported that the region had 4.2 million community health workers that played a vital own role in healthcare services.

SEARO wants the development of a “global health and care workforce compact, accompanied by a five year roadmap aimed at strengthening national workforce capacity and addressing the projected global health workforce shortages”.

Poland, speaking for the European Union and candidate members, stressed that “protection from any form of violence, discrimination, unsafe working conditions, and respect for human rights, as well as due appreciation in all its forms, are preconditions for attracting and retaining the health workforce”.

In light of the shortage of health workers, Poland stressed the importance of “digital upskilling” to address the digital health transition. 

“The WHO Academy offers a unique opportunity to strengthen the skills and capacities of human resources in health,” Poland noted, of the new facility hosted by France.

“Health policies must promote equity and gender responsive approaches support women’s meaningful participation and leadership. Currently, women form 70% of the health workforce, but hold less than 25% of senior roles with a 24% pay gap,” Poland noted.

Dr Bruce Aylward, WHO Assistant Director-General of Universal Health Coverage, said that there that been an increase in the projected gap for health care workers by 2030.

“That is alarming, especially in the context of official development aid cuts that are already hitting some of the most important cadres, like community health workers.”

Smoke billows from chimneys in Poland – generating both air pollution and climate emissions of CO2.

In an eleventh-hour move, World Health Assembly member states on Monday deferred a final vote on a draft WHO Action plan on Climate Change and Health until Tuesday morning – in an effort to find a last-minute compromise with a bloc of oil-rich states trying to put the plan on ice.

The move followed a Russian-backed Saudi initiative over the weekend to postpone approval of the Action Plan until 2026, with the support of other members of WHO’s  Eastern Mediterranean Region.

But in a nearly three hour debate on Monday, few other member states appeared ready to fall in line.

After it appeared unlikely that opponents could muster the votes to delay the plan for a year, WHA delegates recessed into evening consultations in an effort to find an eleventh-hour consensus – and avoid a ballot that would be embarrassing for any losers.

In their comments at the WHA on Monday, dozens of states from Africa, Asia, Europe, the Americas and Pacific Islands, expressed support for the action plan and its immediate approval. The plan maps ways in which WHO can support low- and middle-income nations to adapt to climate change and reduce future health impacts, including impacts on health systems.

CBDR is a legal concept in the 2015 Paris agreement, but doesn’t belong in an action plan, argued the UK delegate.

During the debate, a number of high income states, including the United Kingdom and Australia, as well as developing countries nations expressed differences of opinion over some of the plan’s references to broader UN principles, particularly the “common but differentiated responsibilities (CBDR)” of rich versus poorer nations to take climate action.

The CBDR concept, while embedded in UN climate frameworks, is out of place in an action plan, complained the UK.  India, on the other hand, maintained that “any global plan must align with existing international agreements under the UNFCCC and the Paris Agreement. Central to this is the principle of common but differentiated responsibilities and respective capabilities, which safeguards equity and fairness in global climate action.”

Either way, the action plan remains a voluntary framework and not a legal instrument, its proponents argued. And against the differing interpretations of some passages in the  plan, most agreed that there is an overriding urgency to approving the measure at this year’s WHA session.

‘No time to lose’

Peru, on behalf of nearly 50 states across the Americas, Asia and Europe, calls for immediate adoption of the climate and health plan.

“Instead of delay we need to accelerate actions to address the health impacts of climate change – already visible all over the world,” declared Peru, on behalf of nearly 50 nations across the Americas, Asia and the Western Pacific, Africa and the European Union. “Now, there is no time to lose.”

Mozambique, speaking for the 47-member African Region, said that the group also supported “full adoption of the global action plan on climate change and health.”

Referring to the increased frequency of drought, cyclones and flooding being seen in the region, he added, “the African region is disproportionally impacted by climate change, and although our continent contributes minimal to the global emission it bears the greatest burden… We call for urgent action to build climate resilient health systems across the continent.”  

Unusual rearguard move

The rearguard action by oil-rich member states against the climate action plan was an unusual move, insofar as it follows on from a new resolution on Climate Change and Health that was approved overwhelmingly by the Assembly just last year. At that time, as well, more than  three dozen WHA delegations spoke on behalf of the measure, the first on climate since 2008. See related story:

New Climate and Health Resolution Wins Strong Support from WHO Member States

“The very survival of our species will depend on this,” Colombia said at last year’s debate in May 2024,  deploring the dearth of climate finance for developing nations which have contributed the least to the climate problem.

This year’s Action Plan is supposed to provide just that – helping vulnerable nations access climate finance to bolster their climate resilience in ways that benefit health.

The Plan also aims to empower health sector engagement with climate actors in other sectors that generate significant climate pollution harming health, e.g. transport, household energy, agriculture and nutrition. Finally, it is supposed help health facilities become more climate resilient and support tens of thousands of energy-poor health facilities the world over to gain access to clean and reliable electricity sources.

While Russia decried the plan as duplicative and costly, at $168 million over the coming 2.5 years, its near-term costs are covered by dedicated funding, other member states underlined. And the plan’s costs are still only a fraction of the costs of other resolutions approved at this year’s WHA – some of which have no committed funding at all.

Air Pollution road map endorsed – but meeting target impossible without more climate action

In contrast to the headwinds encountered by the climate plan, a new WHO road map on air pollution and health received a resounding endorsement from all WHO regions, including EMRO, in a debate earlier on Monday. The ambitious measure aims to halve deaths from human-produced sources of air pollution by by 2040.

Helena Naber at the launch of a World Bank report on climate and air pollution synergies at WHO’s Air Pollution and Health Conference in Cartagena, Colombia.

But most experts agree that reducing air pollution is technically impossible without complementary shifts to cleaner energy sources that would also planet-warming fossil fuel emissions.

In fact, in a business-as-usual scenario,  air pollution “will only get worse” over the next 15 years – and that is even if all existing climate and clean air commitments are met, warned the World Bank’s Helena Naber, senior World Bank environmental economist, at an event in Geneva on Friday. She referred to a new World Bank analysis “Accelarating Access to Clean Air for  Liveable Planet,” launched in March.

“Even if countries successfully implement all their energy climate and air pollution control policies and measures that are announced or planned now over the next 15 years, by 2040 we will still see a rise of 21% in the number of people who are exposed to PM 2.5 levels above [the WHO annual guideline] of five micrograms per cubic meter, and this will be due to combined effects of population growth and economic expansion,” Naber said.

“And as a percent increase, the highest will be in Sub-Saharan Africa,” she said.

Conversely, halving the number of people exposed to high PM 2.5 concentrations (above 25 micrograms/cubic meter) by 2040 is feasible and affordable – but only if countries adopt a more “integrated” approach that accelerates the clean energy transition and reduces greenhouse gas emisions, Naber said.

Rising human health and financial costs of climate inaction

Solar panels provide electricity to Mulalika health clinic in Zambia, enabling reliable function of core health services while reducing pollution from diesel electricity generation.
Limiting global warming to 1.5ºC reduces GDP losses by two-thirds.

Meanwhile, the human health and financial costs of non-action on climate change are rising steadily over time – as average temperatures remain at record highs and the impacts of extreme weather grow.

One study published last year by the Swiss Federal Institute of Technology in Zurich (ETH Zurich) and partners, predicted a 10% loss of global GDP if global warming continues to 3ºC – with the worst impacts in less developed countries.

At the same time, limiting global warming to 1.5ºC could reduce the global economic costs of climate change by around two-thirds.

Large proportion of air pollution deaths are from fossil fuel sources

The opposition to the climate change and health action plan is all the more ironic insofar as a large proportion of deaths from air pollution are due to emissions from fossil fuels.

Although estimates vary depending on the method of analysis, between 2-5 million air pollution related deaths can be attributed to emissions from fossil fuel-producing sources.

Notably, diesel fuel which produces high levels of health-harmful particulate pollution, including black carbon “superpollutants” that also accelerate warming, ice and glacier melt.  Emissions of methane, a highly potent climate gas that leaks from oil and gas production, also contribute to the formation of ground-level ozone responsible for a significant chronic respiratory diseases and asthma.

“The Eastern Mediterranean has the highest air pollution sources of all member state regions,” noted Libya, in a statement in support of the WHO Air Pollution Road Map, on behalf of the same EMRO member states that are trying to stall the WHO Climate and health action plan.  “Although natural sources such as [sand] storms are a significant factor, addressing the anthropogenic sources is crucial to improving air quality in the region,” said the delegate.

Of the roughly 7 million premature deaths from air pollution that  annually worldwide, “85% of those deaths are attributed to non communicable diseases, including heart disease, stroke, chronic obstructive pulmonary disease and lung cancer,” the delegate also noted.

In 2015, Saudi Arabia also led an initiative by the EMRO region to block the World Health Assembly’s approval of a first-ever resolution on air pollution on health. Saudi delegates argued in closed door debates that air pollution was largely a product of wood and biomass burning – not fossil fuels – something African member states rejected. After a series of closed door, late-night negotiations, Saudi Arabia and the EMRO bloc it led agreed to go along with the landmark resolution. But the agreement was contingent on the revision of references linking air pollution and climate change, watering down those associations.

Since then the science around the linkages has become even more unequivocal – with more evidence pointing not only to the direct impacts of air pollution created by fossil fuel burning – but also the increased impacts of fossil fuel sources on emissions of super-pollutants, and impacts of air pollution on health when combined with extreme weather, such as heat waves.

Image Credits: Janusz Walczak/ Unsplash, UNDP/Karin Schermbrucker for Slingshot , IIAS.ac.at.

Prof Helen Rees in front of the derelict building that has become the Hillbrow Clinic in Johannesburg, where her institute is based.

“We don’t need faster horses, we need a new model of global health,” says Professor Helen Rees, who received the World Health Organization’s (WHO) 2025 Dr Lee Jong-wook Memorial Prize on Friday for her “outstanding contribution to public health”.

“If there isn’t going to be money, we shouldn’t be trying to run the same things on a third of a budget.

“We have to restructure, focusing on what is going to give us the best return on investment –  things like immunisation, and maternal and child health,” she told the award ceremony last Friday, hosted by the Korea Foundation for International Healthcare (KOFIH) and the Geneva Graduate Institute. 

Rees has spent her entire distinguished career finding solutions to some of the most pressing global health problems, including malnutrition, HIV, cervical cancer, tuberculosis, and access to medicines for low- and middle-income countries (LMICs). 

Although the University of the Witwatersrand in Johannesburg, where she has been based for three decades, faces enormous funding cuts following the immediate withdrawal of US funds, her instinct is to seek solutions.

“The sudden withdrawal of funds is really tough because we’re dealing with patients facing the withdrawal of services; with participants on studies that have suddenly stopped; with people losing their jobs in large numbers who were providing unique services around things like HIV and TB,” Rees told Health Policy Watch before her award ceremony last Friday.

“But the point is now, we have to sit up and say: What is the reset dial? “We need to innovate, prioritise and use digital and AI solutions.”

Leapfrogging to most effective technology

Rees is urging a “rethink of global health” encompassing “global governance, financing, health services, research and [how to] leapfrog to the most effective technology”, she told the award ceremony. 

First, governments and regions need to take more responsibility for the health of their citizens, she says. Back in 2001, African leaders adopted the Abuja Declaration in which they pledged to spend at least 15% of their budgets on health, yet a quarter of a century later, only Rwanda, Botswana, and Cabo Verde has consistently done so.

“Country budgets need to be redirected to health services, and the ‘sin taxes’ [on tobacco, alcohol and sugary drinks] can also be considered. But debt relief needs to come into this. Over 50% of low-income countries are at risk of a debt crisis and the development banks and multilateral organisations also need to rethink what is their model.”

She warns that if there is a substantial rise in HIV infections as a result of the withdrawal of US funding, this will “create a huge reservoir of immunocompromised individuals” that will “facilitate the emergence of new pathogens”.

Wealthier countries need to persist with official development assistance (ODA) to the poorest countries, even if only to protect themselves.

Prof Antoine Flahault, chair of the Geneva Health Forum; WHO’s Dr Suraya Dalil; Prof Helen Rees; Dr Jerome Kim of the International Vaccine Institute and Dr Margaret Chan, former WHO Director-General.

Joining Rees on a panel after her award, Dr Jerome Kim, director-general of the International Vaccine Institute, agreed on the need for a global restructuring, and urged “end-to-end thinking”.

“We can’t just have a vaccine. We have to have a plan to use it. We have to know that it’s going to be cost-effective. We’re not just developing vaccines for the companies. We’re developing them to be used and to have impact,” said Kim.

“The rotavirus vaccine was approved in the US in 2006. It was approved by WHO and recommended in 2009. Now, in 2025, 60% of the world’s children still don’t receive all the doses of rotavirus vaccine,” Kim pointed out.

Innovative financing

Rees cites MedAccess, which she chairs, as an organisation that is looking at getting health products needed by LMICs “through innovative financing, health and volume guarantees”.

We need “better, smarter technologies, that make health services easier to administer, medicines easier to store and transport.

To address the worldwide shortage of health workers, resulting in crowded clinics and overloaded nurses, Rees wants technology “to enable patient-responsible care”, such as tools to self-monitor chronic conditions.

There needs to be facility-level digitisation to manage clinic appointments, ensure patients are collecting medication and identify outbreaks.

Then, says Rees, “we need to make the products we deliver easier for patients”. A key example is long-acting lenacapavir, an antiretroviral medicine that prevents HIV via two annual injections.

Finding solutions for the most vulnerable 

British-born, Rees has spent her career based in southern Africa finding solutions to health problems of people living in poor settings in roles ranging from paediatrician to researcher, academic, policy-maker, drug regulator and international adviser.

The common thread in all these roles is her desire to improve the lives of those most vulnerable – social justice values she gets from a family of Welsh coalminers, trade unionists, teachers and preachers.

Rees and her South African husband, Dr Fazel Randera, met when they were medical students in the UK and, on graduating, they went to newly independent Zimbabwe to apply their skills.

Rees was a paediatrician, and her malnourished little patients inspired her and colleagues to encourage parents to fortify the maize meal they were weaning their children on by adding locally grown nuts. 

Looking at the bigger picture to find population-level solutions was a no-brainer for Rees from the start.

Solving problems with research and technology

Prof Rees in the Hillbrow Clinic.

“It is really about identifying the problem, prioritising a research agenda, and then looking for appropriate technology, then looking at implementation, science, policy, governance, finance, access and community and trust,” Rees told the award ceremony of her professional approach.

Rees’s 10 essential lessons

Understanding this essential chain “took a while”, and has come through many years of experience.

In 1980, she and Randera left Zimbabwe for South Africa, where they were quickly drawn into trying to address the effects of apartheid from Alexandra Clinic, a donor-funded health oasis in a densely crowded Black-designated township in Johannesburg.

“The townships were on fire,” says Rees. “The first grant I ever got was to set up an emergency services group for youth in townships who were being shot, were being frightened and persecuted. We trained them in emergency first aid, and we gave emergency equipment.”

By the time South Africa overcame apartheid in 1994, HIV was emerging as a major challenge – particularly for young women.

Rees started the Wits Reproductive Health and HIV Institute (Wits RHI) at the University of the Witwatersrand, which has become one of the country’s most important research institutions.

The institute is based at Hillbrow Clinic, an inner-city slum in Johannesburg, where a collection of derelict buildings was transformed.

“Where I have physically worked has always integrated the needs of underserved communities with research and clinical services,” Rees explains.

Several key trials have been run from the clinic, which also provides healthcare to the community, particularly to mothers and children.

Building a new country

“How do you jump from clinical to research and then into policy and governance?” Rees asks, then answers by saying that South Africa was “looking towards a new country” in the late 1980s.

She was drawn into this quest, first assisting in writing a new health policy for the government-in-waiting, then working on several clinical trials that guided policy, including pioneering research on human papillomavirus (HPV) vaccines and operational research on infectious disease control strategies in the most vulnerable settings.

Then she jumped into governance when appointed to chair of the board of South Africa’s medicines regulator, the Medicines Control Council (MCC).

One of the unexpected challenges she encountered as a regulator was when former President Thabo Mbeki denied that HIV causes AIDS, and pressured the regulator not to approve nevirapine for prevention of mother-to-child HIV infection.

Precious Matsoso delivered congratulations to Rees on behalf of the South African government at the award ceremony.

She and the Registrar of Medicines, Precious Matsoso, who recent co-chaired the WHO pandemic agreement negotiations, registered nevirapine anyway – and cemented the principle of science over politics.

Rees still chairs the board of the South African Health Products Regulatory Authority, the successor of the MCC. 

More recently, she has assisted African countries with the Ebola, COVID-19, and monkeypox epidemics on several groups, including as chair of WHO’s African Regional Technical Advisory Group on Immunization and a member of the WHO African Regional Emergency Preparedness and Response Technical Advisory Group.

She also chairs and participates in several global WHO expert scientific committees on global vaccine policy and health emergency preparedness, and served on the WHO Strategic Advisory Group of Experts on Immunization (SAGE) for several years.

Back home, Wits RHI is leading a vaccine trial for TB vaccine (funded by the Gates Foundation and Wellcome Trust), and researching how to roll out lenacapavir, the long-acting antiretroviral for pre-exposure prophylaxis.

In recognition of her immense contributions to science and public health, she has received numerous prestigious awards, including the Order of the Baobab of the Republic of South Africa, the Gold Medal of the South African Academy of Science and an Officer of the Order of the British Empire (OBE).

But Rees said that her greatest achievement is her family. She has three children – raised with “benign neglect”, she laughs – and four grandchildren.

Image Credits: ARD.

Chikwe Ihekweazu, the first director-general of the Nigeria Centre for Disease Control and currently head of the Health Emergencies Programme for the World Health Organization, believes that greater African leadership in global health organizations would benefit everyone.

“These roles require not only technical competence, but also empathy and compassion, which I believe can only develop with time and experience,” Ihekweazu told Garry Aslanyan, host of the Global Health Matters podcast. “Global health indices will benefit greatly from more diverse representation at all levels of leadership.”

A Nigerian infectious disease epidemiologist, Ihekweazu brings extensive experience in public health leadership. He and his wife, Vivianne Ihekweazu, were featured on the Dialogues show to discuss their new book, An Imperfect Storm: A Pandemic and the Coming of Age of a Nigerian Institution. The book chronicles his tenure as the founding director general of the Nigeria Centre for Disease Control from 2016 to 2021, a period in which he played a pivotal role in strengthening Nigeria’s public health infrastructure—particularly in the lead-up to the COVID-19 pandemic.

Under his leadership, the Nigeria CDC became a central force in Africa’s pandemic response.

Vivianne Ihekweazu also works in health, serving as managing director of Nigeria Health Watch.

Listen to the full episode:

Listen to more Global Health Matters podcasts on Health Policy Watch >>


Please note: This article corrects an earlier error. Chikwe Ihekweazu was the first director-general of the Nigeria CDC, but not its founder.

Image Credits: Global Health Matters, TDR.

Saturday’s WHA session saw the approval of multiple resolutions, including new measures on health finance, rare disease and skin diseases.

The 78th World Health Assembly picked up momentum Saturday as countries adopted a Nigeria-sponsored initiative to stimulate more public health spending; and  first-ever WHO resolutions recognizing rare diseases and neglected skin diseases as global equity issues.

The resolution on strengthening health finance globally aims to accelerate progress towards long standing commitments on financing Universal Health Coverage. 

It echos a 2019 UN General Assembly appeal to governments to allocate “an additional 1% of gross domestic product or more for primary healthcare.” 

And it highlights potential fiscal levers that could raise more revenues for healthcare, such as “introducing and increasing taxes on tobacco, sugar and alcohol…  that reduces risk factors for noncommunicable diseases.”

Member states also are encouraged “to focus domestic resources on an affordable package of essential health benefits, based on evidence and developed through inclusive and transparent processes supported by health technology assessment.” 

The resolution is also noteworthy because it was initiated by Nigeria, Africa’s most populous nation. 

Countries’ commitments to finance UHC are way off track   

From 2020-2022, domestic public health expenditure (blue line) stagnated or declined while out of pocket spending (red line) grew fastest in the poorest countries, with donor funding filling in the gaps. Ke Xu, WHO health economist, presents latest data in December 2024.

Citing findings from the WHO’s 2023 Global Monitoring Report, the resolution notes that “the world is off track in making meaningful progress towards universal health coverage and alignment with the Sustainable Development Goal indicators  by 2030.”

According to the draft resolution, almost two billion people globally continue to face financial hardship from health expenditures, and over 340 million are being pushed or further pushed into extreme poverty due to out-of-pocket spending. “One billion people globally [are] spending more than 10% of their household budgets on healthcare,” the resolution states, noting the urgency for reforms.

While there was a 60% increase overall in per-capita health expenditures between 2000 and 2022 –  in low income countries this was largely driven by a sharp rise in out-of-pocket spending (OOP), a December 2024 WHO report on public health expenditures found. 

The spending outlays fall far below the longstanding commitments of the 2001 Abuja Declaration, in which member states pledged to set aside at least 15% of their national budget for the health sector. 

Over the last two decades, donor outlays made up for the stagnation in domestic spending on public health systems in the poorest countries, according to the December 2024 WHO report – but now that support has been cut drastically, due largely to the massive US reductions in global health outlays.

WHA Resolution urges member states to improve social protection 

Examining a pregnant woman. In the lowest income countries, out of pocket costs for basic procedures have soared since 2020.

The new WHA resolution urges member states to “tackle the causes of poor financial protection and improve access to healthcare services without financial hardship.” 

It emphasizes the importance of prioritizing public financing for health systems, encouraging governments to focus on “government revenue as the primary source of financing,” and recommends reducing fragmentation through “pooling of government funds, including revenue from direct and indirect taxes and levies, where applicable.”

Finally, the resolution also encourages global health initiatives, donors, and financial institutions “to finance domestic priorities with consideration of favourable terms, aligned with country planning, budgetary processes, monitoring and evaluation cycles,” and calls for improved transparency and reporting through systems such as national health accounts.

The resolution requests WHO “to prepare reports on health expenditures and the state of global health financing to be presented in 2026, 2028 and 2030” and to “provide support for improvement in the quality and availability of data and in the timeliness and transparency of tracking domestic and external financing flows.”

In the light of WHO budget cuts, that’s a politically significant request in that it should help preserve WHO’s work tracking public health spending by countries and regions. See related story. 

Public Health Spending in Low Income Countries Stagnates – Out of Pocket Costs Soar 

To support country-level reform, the Director-General is also asked to support member states in “the development of prioritized national health financing road maps to mobilize technical assistance and financial resources.” 

Strong support from member states 

The resolution, initiated by Nigeria, had strong support from Member States, with several highlighting national efforts to scale up domestic financing.

 Zimbabwe reaffirmed its commitment to sustainable health investments, announcing plans for a “proposed national health insurance scheme to ensure sustainable and equitable health.” This aligns with the resolution’s call for countries to reduce reliance on out-of-pocket expenditure and prioritize pooled, public funding for healthcare.

Public Services International, representing global public sector workers, called on Member States “to walk the talk of adequate public funding,” warning that the increased privatization of healthcare “undermines the essence of UHC.” They urged debt cancellation for developing countries to free up fiscal space for primary healthcare investment, and emphasized the importance of treating health workers with fairness and dignity—echoing the resolution’s provisions on workforce protection.

The International Federation of Medical Students Associations also backed the resolution, calling it a timely response to growing inequities. They advocated for “sustainable public health financing to reduce out-of-pocket costs” and emphasized that health system reforms must be “grounded in equity and people-centered primary healthcare.”

Ailan Li, Assistant Director-General for Universal Health Coverage at WHO, reaffirmed WHO’s commitment to supporting countries in implementing the resolution’s recommendations, noting that financing reform “is at the core of our work as we go forward.” .

First rare diseases resolution also approved

Incentives for R&D into new ‘orphan drugs’ for rare diseases are few – due to the comparatively low numbers of people affected.

During the session, Member States also unanimously adopted the resolution Rare diseases: a global health priority for equity and inclusion, the first of its kind within the WHO framework. 

A rare disease is described as a specific health condition affecting fewer than 1 in 2000 individuals in [the] general population, according to the resolution, which places rare diseases firmly within the global UHC and equity agenda.

Over 300 million people globally are living with one of more than 7,000 known rare diseases, many of which are chronic, disabling, and often undiagnosed or misdiagnosed, the resolution notes. 

Li called the measure a “landmark”. 

“These are complex issues to manage, they are expensive issues to manage, and that is the reason that we brought it into [WHO’s] GPW 14, with the support of so many member states and partners,” she said. She confirmed that WHO would proceed with the development of a 10-year global action plan, to be presented at  the World Health Assembly in 2028.

Beyond policy symbolism, the resolution outlines tangible action points: it urges countries to integrate rare diseases into national health strategies, improve access to diagnosis and treatment, and develop registries and data systems. It also emphasizes social inclusion, noting that individuals with rare diseases often face “stigmatization, social exclusion, and limited access to essential services.”

The adoption of the resolution was widely praised by civil society and health organizations advocating for rare disease patients. Delegates welcomed WHO’s commitment to ensure that “persons living with a rare disease… receive timely and appropriate healthcare services,” including through improved diagnostics, workforce training, and dedicated research efforts.

Strengthening medical imaging capacity and tackling skin diseases  

Over 600 million people are at risk of visceral leishmaniasis,transmitted by sandflies, which affects the spleen and liver, and is almost always fatal if untreated. After treatment, patients can also be stricken with a dermal form of the parasitic disease.

In other actions Saturday, the Assembly approved several more resolutions on:  strengthening medical imaging capacity; bolstering national uptake of norms and standards (EB 156/17 and EB156/14); raising the profile of skin diseases as a global health priority (EB156/24). It also endorsed a strategy for accelerating the eradication (Guinea Worm Disease) dracunculiasis (EB156/23) and reviewed progress on the 202o roadmap for accelerating the elimination of meningitis by 2030 (A78/4).  

“Over 10% of skin diseases are NTDs which disproportionately impact underserved communities in LMICs and cause physical, mental and social harm, yet diagnosis is limited and many treatments are outdated or toxic,” noted a representative of the Drugs for Neglected Diseases Initiative. 

Cutaneous leishmaniasis is a milder form of the disease, also common in the Middle East and parts of North Africa as well as Latin America.

“We support the resolution’s focus on R&D and access to health tools, but commercial R&D systems continue to neglect skin NTDs. Governments must drive innovation through collaborative models that prioritize patient needs and build local capacity, domestic leadership and regional collaboration is key.

“The recent Memorandum of Understanding signed this week by six African countries on visceral leishmaniasis elimination demonstrates the power of coordinated cross border efforts. National political commitment is vital through integrating skin NTDs into health plans, resource allocation and training frontline healthcare workers to improve early detection and care.”

See related story here: 

https://healthpolicy-watch.news/cross-border-collaboration-gains-political-traction-as-africa-targets-visceral-leishmaniasis-elimination/

Image Credits: Abanima at the Arabic language Wikipedia, CC BY-SA 3.0, , Twitter: @WHOAFRO, WHO, DNDi.

Member states discussing NCDs in the World Health Assembly’s Committee A

“This is the most important year in the history of non-communicable diseases (NCDs),” declared Richard Horton, editor of The Lancet, at the World Heart Federation’s (WHF) 2025 Summit on the eve of the World Health Assembly (WHA).

ON 25 September, the United Nations (UN) hosts the Fourth High-Level Meeting (HLM) on NCDs and mental health. The world’s biggest killer is a major focus of this week’s World Health Assembly, as WHO, member states and civil society gear up for the September event.  In the lead-up, the WHA also approved new initiatives promoting the better integration of kidney health,  lung health, as well as vision impairment and hearing loss into primary healthcare systems. 

But industry interference, lack of funds and poor policies and enforcement at country level remain critical obstacles in the pathway to raising the level of ambition for the High Level Meeting – and effectively reducing NCDs. To date, only 19 countries are on track to meet the global target of reducing NCDs by a third by 2030.

Out of the 19 countries on track, 10 are European nations, as well as high-income New Zealand, Singapore, and South Korea.

“Progress has stalled since 2015,”  a spokesperson for NCD Alliance (NCDA) told the WHA’s Committee A on Friday. “This stagnation is not due to a lack of evidence, but as a result of under-investment in health systems and health-harming industry interference.”

UN’s ‘zero draft’ declaration

The UN High Level Meeting on NCDs will take place on September 25, on the margins of the General Assembly meeting in New York City.

The Zero Draft of the HLM’s political declaration focuses on three key priorities: tobacco control, hypertension and improving mental health care. It proposes global targets of: 150 million fewer people using tobacco, 150 million more people controlling their hypertension and 150 million more people having access to mental health care by 2030.

NCDA CEO Katie Dain said that the positives of the draft are concrete targets, situating health as part of the broader development nexus and elevating mental health issues, as well.

The draft advocates for countries to impose excise taxes on tobacco, alcohol, and sugar-sweetened drinks at levels recommended by the World Health Organization (WHO) to help achieve this – a policy that is gaining more global traction now in light of the drastic funding cuts for global health.

Taxes on unhealthy foods and sugary sweetened beverages (SSBs), by country as of June 2024.

The NCDA and other civil society groups have been advocating for such taxes for several years as they offer a” triple win of raising revenue, reducing consumption of unhealthy products, and so reducing health costs”, said Alison Cox, the alliance’s director of policy and advocacy.

The NCDA also wants a tax on ultra-processed food high in fat, salt, and sugar and  “corrective taxes on fossil fuels” – as well as “subsidy reforms that support access to healthy, sustainable diets and clean energy sources”, according to its response to the zero draft.

Taxes – and bribes

Dr Viroj Tangcharoensathien (left), Dr Tom Frieden,  World Heart Federation (WHF) president Dr Jagat Narula, Nupur Lalvani and NCD Alliance CEO Katie Dain address the World Heart Federation Summit Sunday, 18 May, on the eve of the World Health Assembly.

While many see taxes as a panacea, Dr Viroj Tangcharoensathien of the International Health Policy Program in Thailand, warned that poor governance in some low- and middle-income countries (LMICs) has enabled harmful industries to bribe officials to undermine taxes.

Around 42% of high income countries have met the 75% tobacco tax rate recommended by WHO, in comparison to only 12% in LMICs and 3% in low–income countries, he told the WHF summit.

Dr Tom Frieden, a former director of the US Centers for Disease Control, who now heads Resolve to Save Lives, told the summit that “only 13% of people live in countries where there’s adequate tobacco taxation.”

Frieden added that issues undermining effective NCD taxes include “bribes from the killer industries to the people who make decisions; payment of farmers to go grow tobacco when it’s not economically viable but they want the tobacco farmer lobby in the country; payment to ‘astroturf groups’ in country to lobby [and] payment to news entities to cover taxation as if it’s a form of extortion.” 

Climate and NCDs: deepening links and demands for WHO support

A fire in a favela in Brazil

Over the past week at the WHA, WHO member states have described both their NCD problems, how they are addressing them, and the help they need – with the underlying lament being the lack of resources.

Several countries spoke about climate-related issues that are both exacerbating the NCD burden as well as hampering access to treatment – in extreme weather scenarios for instance. 

Three-quarters of deaths in countries in WHO’s Western Pacific region are from NCDs, but “the adverse effects of climate change, frequent natural disasters and other competing priorities have impeded progress on all aspects of NCD prevention and control”, Samoa told the WHA, speaking for the region’s nations.

Assistance for Small Island Developing States (SIDS) in the Pacific and other regions, needs to address “the environment-nutrition nexus”, added Samoa.

Notably, a new WHO draft action plan on Climate Change and Health is up for consideration by member states at this WHA session.

Despite the huge demand from many low- and middle-income member states for WHO support to address burgeoning climate-related health impacts, a final debate on the new WHO action plan was delayed until Monday, after a major oil producing state started to raise last minute objections, Health Policy Watch, has learned.  

Sight, hearing, kidney and lung health

Construction worker in Texas, where the state governor in 2023, order the cancellation of municipal rules in Austin and Dallas mandating water breaks for outdoor workers.

On Friday, the WHA also approved three resolutions that aim to: improve the detection of vision impairment and hearing loss at primary healthcare leavel, as well as ensuring better integration of kidney health and lung health prevention, diagnosis and treatment into PHC.

Member states also supported 17 November being observed as World Cervical Cancer Elimination Day to increase global awareness of the only cancer that can be prevented by a vaccine.

Around 9% of the global population lives with kidney disease, one of the fastest-growing causes of death globally that is projected to become the fifth leading cause of death by 2050, according to the WHO, WHA delegates also noted in the debate. 

That issue, as well, is closely associated with climate change in largely unrecognized ways. Namely, outdoor workers’ exposures to rising temperatures exacerbates risks of dehydration and heat stress, which over time, can lead to kidney failure. 

The problem of growing heat stress is worldwide – including high-income countries such as the USA, where the state of Texas, in 2023, cancelled rules requiring outdoor workers to get regular water breaks.

Concerns about kidney failure among outdoor workers returning home from Gulf countries have also gained traction, as per a 2022 report by the Vital Signs Project, by a coalition of NGOs in Nepal, the Philippines, Bangladesh and the United Kingdom, which aim to raise awareness about migrant worker deaths in Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the UAE. 

Air pollution a major driver of NCDs

Related to that, air pollution is also one of the world’s biggest drivers of NCDs, including heart disease and high blood pressure as well as  chronic lung disease and lung cancers. And yet it has remained a kind of “orphan” issue in the NCD agenda, with no target for reducing harmful air pollution exposures proposed in this year’s High Level Draft Declaration either.

In fact, more than half of the 7 milllion deaths from air pollution are in fact due to cardiovascular diseases, namely heart disease and stroke, according to a World Heart Federation analysis released during last year’s World Health Assembly.  Already, cardiovascular disease is the world’s top killer, claiming more than 20 million lives each year.

And “this will only get worse” over the next 15 years, warned the World Bank’s Helena Naber at a clean air event in Geneva on Friday, reporting on the results of a new Bank analysis.

Air pollution darkens ski in Delhi during a November 2024 seasonal emergency.

“Even if countries successfully implement all their energy climate and air pollution control policies and measures that are announced or planned now over the next 15 years, by 2040 we will still see a rise of 21% in the number of people who are exposed to pm 2.5 levels above [the WHO guideline] of five micrograms per cubic meter, and this will be due to combined effects of population growth and economic expansion – and as a percent increase, the highest will be in Sub-Saharan Africa.”

While the ballooning array of NCDs is a challenge, even for the most advanced countries, for low and middle income countries, the combined effects of dirty air, unhealthy foods, alcohol and tobacco are even more devastating in low and middle income countries that lack the health system resources to cope.  

Meanwhile, low-income countries such as Cameroon told the WHA that the increase in NCDs, particularly diabetes, has come with “exorbitant costs and unequal access to innovative technology, medication and treatment”. 

Ambitions for the UN High-Level Meeting

Unhealthy and ultraprocessed foods are adding to NCD risks in developing countries.

Poland, representing the European Union, told the WHA it wants “an ambitious, human rights and evidence-based political declaration” at the HLM to reverse the lack of progress on NCDs.

“We call for a comprehensive approach to NCDs and mental health across the life course. This includes health promotion, prevention, early detection, diagnosis, treatment, rehabilitation and palliative care,” said Poland.

Denmark, representing the Scandinavian countries, Iceland, Estonia, Lithuania and Latvia, expressed three ambitions for the HLM declaration: that it strengthens prevention and health promotion; addresses risk factors behind NCDs and poor mental health, including tobacco, nicotine products, alcohol and unhealthy foods; and protects people in vulnerable situations. 

In this regard, it wants children and adolescents protected “from harmful digital exposure and irresponsible marketing of alcohol, tobacco, nicotine and unhealthy foods”.

Women take part in a programme to prevent NCDs by promoting healthy diets in Tulagi, Solomon Islands.

Portugal called for “reshaping” where people live and make decisions. “Healthier food systems, active mobility and protection from harmful exposures must become the norm. This requires active engagement, not just of health ministries, but also education, urban planning, transport and the private sector,” Portugal told the WHA.

Australia acknowledged the complexities: “NCDs must be addressed by tackling the wider determinants of health,” but “the risk factors are complex, interconnected and extend far beyond individual health behaviours.”

Addressing the WHA on Friday, the World Heart Federation appealed for more ambitious targets to address cardiovascular disease, including “targeted action to treat 500 million more people with hypertension by 2030 and for 50% global hypertension control by 2030; at least 50% excise tax on tobacco, alcohol and sugar sweetened beverages, and the adoption of WHO air quality guidelines”.

The World Heart Federation speaker appeals for more ambitious targets to end NCDs in the UN political declaration.

A range of other non-state actors addressing the WHA called for an end to “siloed approaches to NCDs” – although they, too, are organised in silos.

NCDA CEO Katie Dain told the WHF summit that the HLM needs to “be about implementation of what works, investment and financing, particularly with a strong call for health taxes, and integration of NCDs” into PHC and universal health coverage.

But the challenges are enormous, particularly in light of dwindling finances. 

“It is only during a crisis that you can make disruptive change,” said Gavi CEO Sania Nishtar. “This crisis [of unprecedented financial disruption] is a moment for us to revisit the duplications, the fragmentation, the mission creep that crept into the system over time.

“We need a ‘one-window’ [health] system” for a woman who comes to a primary health care facility via public transport and needs her contraceptive, child immunisation and NCD needs addressed all at once, Nishtar told the WHF summit.

-Elaine Ruth Fletcher contributed reporting to this story.

Image Credits: Sven Petersen/Flickr, WHO, United Nations , WHO, Denys Argyriou/ Unsplash, Josh Olalde/ Unsplash, Chetan Bhattacharji, WHO / Blink Media, Neil Nuia.

A plastic bag floats underwater near the surface in Bali, Indonesia. At current rates, plastic waste is expected to outweigh all fish in the sea by 2050.

Thirty-five million tons of plastic waste have been dumped into the world’s oceans since negotiations on the United Nations plastics treaty began in Uruguay two years ago.

When delegates gather for the final session of UN Environment Programme (UNEP) led talks in Geneva in August, known as INC-5.2, around 1.2 billion tons of unrecycled plastic waste will have been produced since negotiators from 175 nations first put pen to paper.

With plastic production set to rise 40% in the next decade, tens of billions of tonnes of large, small and microscopic chemical particles will scatter throughout rivers, landfills, streams and coastlines, be burned into the air, or discarded in oceans around the world. 

All of them pose a direct threat to human health and the environment.

Ana Paula Souza discovered this firsthand when she participated in a scientific study last year. Despite living what she calls “a very ordinary life” in Geneva far from recycling plants or petrochemical facilities, tests revealed she had been exposed to more than 30 toxic chemicals that leach from plastics—compounds that can disrupt hormones, damage the nervous system, and weaken immunity.

“We live in a world where, just by walking on the street, you’re already being exposed to plastics,” Souza, who works on environment and climate change issues for the UN’s human rights office, told a gathering at the Geneva Graduate Institute on Wednesday, ahead of the upcoming treaty talks. “I’ve been exposed, and you too, without our consent.”

The upcoming Geneva talks may be negotiators’ final chance to achieve what UNEP and environmental groups call “the most important multilateral treaty” since the 2015 Paris climate agreement.

The negotiations pit over 100 nations advocating for caps on plastic production and chemical regulation against petrochemical giants including Saudi Arabia, the United States, Russia, and China—countries that view plastics as a crucial revenue stream as renewable energy threatens fossil fuel demand.

With all 175 countries required to agree by consensus, and talks having already failed in Busan, South Korea, in November, the path forward remains uncertain.

“There is little assurance that the next INC will succeed where INC-5 did not,” the Global Alliance for Incinerator Alternatives said after the Busan talks collapsed. “There is a strong probability that the same petro-state minority will continue their obstructionist tactics and further imperil the plastics treaty process.”

For health researchers, mounting evidence of the plastic threat is becoming impossible to ignore.

Planetary experiment with unknown consequences

The convenience, cost, durability and usefulness of plastics in industries from fashion to food, medicine, construction and healthcare has led to a societal addiction that has become a planetary-scale human health experiment. Despite their lightweight design, humanity has produced 8.3 billion metric tons of plastic—with 6.3 billion metric tons discarded as waste.

Plastics have grown immensely in chemical complexity since their invention, evolving from simple fossil fuel derivatives into materials containing thousands of synthetic compounds. They now surround us—in our food, air, water, and rain. Yet we remain largely unaware of the potentially toxic effects of thousands of these chemicals now ubiquitous in modern everyday life.

Researchers have identified over 16,000 chemicals used in plastic production, with at least 4,200 considered “highly hazardous” to human health and the environment, according to a landmark report published last year by scientists at the Norwegian University of Science and Technology (NUST).

Around 5,000 of the compounds in plastic are total unknowns—scientists have not sufficiently studied them to understand their toxicity, leaving potential health effects up in the air.

The 16,000 are also just those scientists have been able to identify—the report’s authors admit there are likely many more compounds out there they haven’t caught yet. Only 980 hazardous chemicals— 6% —are currently regulated by international treaties.

“Chemicals present in plastic products cause hazards such as cancers, genetic mutations, and harm to the reproductive system,” said Albert Magalang, a Philippine environment and climate change specialist who is a member of his country’s national delegation to the treaty talks. “I know for a fact that the health sector is aware that about 10,000 chemicals are used in plastics [for which] they don’t have any hazard data.”

Science and regulation can’t keep pace

Just 6% of all plastic chemicals are regulated under multilateral environmental agreements. Around 1000 additional compounds are regulated at the national level by a small number of states.

The regulatory challenge is compounded by industry practices. When authorities restrict or ban chemicals, manufacturers often replace them with structurally similar substitutes that carry the “same or other unknown hazards,” according to the Plastics Health Map, an open-source database mapping research on plastic chemical exposures.

The pace of scientific evaluation adds another layer of delay. Studies on the health impacts of substitute chemicals typically commence years after their introduction to the market, creating a perpetual knowledge gap. As plastic chemicals proliferate faster than research can evaluate them, both regulatory systems and scientific understanding struggle to keep pace with determining their health effects.

This regulatory gap reflects a deeper problem: the vast majority of plastic chemicals lack basic safety information. Researchers don’t know their identities and structure 25% of the time, their functions 50% of the time, whether they’re present in plastic 56% of the time, and their hazards 66% of the time, the NUST report found.

“We face a major challenge in the lack of transparency across the plastics value chain,” said Andrea Zbinden, senior policy advisor for the Swiss Plastics Treaty delegation, which will host the talks in August. “I want to know, actually, what is in the plastic product that I’m using every day.”

Despite this knowledge gap—likely to persist for decades as new chemical compounds continue to multiply—leading health experts believe human health must be central to negotiations on the plastics treaty, which will be legally binding but requires consensus to pass.

“Human health must be central to the plastic treaty,” said Dr Maria Neira, WHO’s environment lead. “Plastics pose risks to human health, and the risks are happening across the entire life cycle, from production to destruction and then use and disposal.”

The push for binding global action

Picking through waste in Banjar City, Jawa Barat, Indonesia

The demand for transparency is driving Zbinden and a group of 94 countries to push for a global list of banned chemicals and plastic products—something that has proved contentious in negotiations. Given how quickly manufacturers replace regulated chemicals with similar compounds, Zbinden insists the list must be regularly updated to reflect the latest science.

“The treaty must also include a mechanism to regularly update the list based on the latest science and development,” Zbinden said. “While every effort should be made to reach consensus, it is important to establish a clear procedure for decision making to ensure the list can be updated effectively.”

Major plastic producers have strongly opposed including such measures. During negotiations in Busan, references to “chemicals of concern included in plastic products” were dropped from the Chair’s Text, raising concerns that obstruction from industry may force countries supporting the strongest health measures to pursue separate commitments outside the treaty framework if consensus fails again.

Support for strengthening the plastic treaty has grown steadily. Char shows the number of nations backing WWF’s “must-haves”: global chemical bans, circular economy design requirements, financing, and guarantees to strengthen the treaty over time.

The most ambitious coalition of nations is pushing for sweeping changes that extend far beyond chemical bans. In a position paper released after the failed Busan negotiations, the 70 countries comprising the High Ambition Coalition reaffirmed their “common ambition of ending plastic pollution by 2040” and emphasized that “effective and common legally-binding global rules are essential.”

They want binding transparency and reporting requirements on plastic polymer production and chemical composition, time-bound targets to reduce production and consumption of primary plastic polymers to sustainable levels, as well as enforcement of the principle that “polluters should be held responsible for their activities and products.”

The coalition’s concerns extend to another health threat: microplastics—particles so small they can cross into organs and the bloodstream.

Research in this emerging field has revealed that microplastics can alter cellular behaviour in internal organs, with scientists identifying a new condition called “plasticosis” in studies of birds. Humans now consume approximately five grams of these particles weekly through normal eating, drinking and breathing, yet their long-term health impacts remain largely unknown.

“We call on all INC members to seize this historic opportunity to conclude an ambitious and effective treaty that demonstrates our collective resolve to end plastic pollution for the benefit of current and future generations,” the coalition stated. “We encourage everyone to continue their efforts, hold governments to account.”

Economic case for action

The coalition’s sweeping demands are backed by mounting evidence that inaction carries enormous economic costs in health damages.

Plastic pollution isn’t cheap, especially for health systems. A study published last year by the Endocrine Society found that chemicals used in plastics generate over $250 billion in annual health costs in the United States alone.

In the European Union, researchers estimate exposure to hormone-disrupting chemicals costs over €150 billion annually in health care expenses and lost earning potential. These endocrine-disrupting chemicals are present in everyday products and pesticides, but industry lobbying has delayed EU action to identify and restrict their use.

With microplastics now found in human blood and plastic production showing no signs of slowing down, UNEP has warned that the economic costs of inaction on the chemical and plastic pollution crisis could reach 10% of global GDP.

These costs are not borne by plastic producers—they’re shouldered by public health systems and taxpayers. As governments spend billions treating the toxic effects of plastic derivatives, the petrochemical industry continues its lucrative expansion, with market value projected to grow from $584.5 billion to $1 trillion by 2030.

“Where is the implementation of the polluter pays principle? A lot of resources are spent from public taxpayer money to deal with the pollution and the negative externalities,” said Julia Carlini, an observer to the treaty negotiations from the Centre for International Environmental Law. “They are profiting from the extraction of fossil fuels and selling plastic products without paying their fair share.”

Despite the scale of estimated damages, economic arguments haven’t guaranteed action in other environmental crises. The World Bank estimated that air pollution causes $8.1 trillion in annual health damage, but that figure hasn’t moved the needle in UN climate talks. The challenge now is whether financial pressure will prove more persuasive than health concerns in pushing through a strong plastics treaty.

Political battle ahead at INC-5.2

With the final leg of negotiations just months away, it remains unclear how health will be integrated into the final treaty, if at all. The latest negotiating document includes a dedicated health clause, though nations have not agreed on this provision and it’s unclear how many support the approach.

During previous talks, countries argued over whether health should be addressed in a standalone provision, woven throughout the treaty, included in overarching provisions, or excluded entirely. Some delegations questioned whether health falls within the treaty’s scope at all.

The World Health Organization has stated it is “open to including a standalone article on ‘Health’ provided that health considerations and protections are included as a cross-cutting issue throughout the text.”

Many of the treaty’s core flashpoints have direct health implications. Articles Three and Six—which address regulating toxic chemicals in plastic production and capping new virgin plastic production—would deliver significant downstream health benefits.

Virgin plastic production depends 98% on fossil fuels, driving air pollution and environmental contamination. Toxic chemicals in plastics can enter the human bloodstream and cause severe health effects, particularly in vulnerable communities living near production or disposal sites.

“If we are going to [target] upstream interventions, it means reducing the unnecessary plastic production, especially in those single-use plastics,” Neira said.

Massive expansion of petrochemical production in the US, China, Saudi Arabia and Russia makes them unlikely to agree to the most ambitious demands from health and environmental advocates. Over 220 fossil fuel industry lobbyists attended the latest talks in South Korea, many embedded within national delegations, according to the Center for International Environmental Law.

The US made a stunning reversal under Joe Biden ahead of the last negotiating round, surprising observers by backing production reductions and aligning with the European Union, Canada and the High Ambition Coalition. But with Donald Trump in office, that support has evaporated.

“The treaty, and especially the notion that the best way to reduce plastic pollution is to scale back plastic production, will go nowhere in the United States,” PlasticsToday, an industry outlet, wrote following Trump’s victory. “And for the vast majority of the plastics industry, that is, indeed, an answered prayer.”

Image Credits: Naja Bertolt Jensen, Muhammad Numan, Fiqri Aziz Octavian, Antoine Giret.

Addressing today’s global health challenges requires more than funding and innovation—it demands humility, open communication, and a shared commitment to collective action, according to IFPMA Director-General David Reddy.

Reddy, speaking at an IFPMA side event during the 78th World Health Assembly, acknowledged the socio-political and financial barriers facing global health systems. However, he urged the audience not to lose sight of the hard-earned lessons from the COVID-19 pandemic.

“Some of the lessons during the pandemic were hard, and they cost this global community a lot,” Reddy said. “We shouldn’t let what they have taught us about the importance of health care slip out of mind so easily.”

The evening’s event explored how health can serve as the foundation for driving economic growth and national security, through partnership and political leadership.

The panel discussion featured three speakers, each offering a unique perspective: Dr Ricardo Baptista Leite, president of the UNITE Parliamentarian Network for Global Health, Dr Kerri Elgar, senior policy analyst at the Organization for Economic Cooperation and Development (OECD) and Dr Jenelle Krishnamoorthy, MSD’s head of global public policy.

From left: Dr. Jenelle Krishnamoorthy, Vice President and Head of Global Public Policy for MSD; Dr. Kerri Elgar, Senior Policy Analyst at the OECD; and Dr. Ricardo Baptista Leite, Founder & President of the UNITE Parliamentarian Network for Global Health
From left: Dr. Jenelle Krishnamoorthy, Vice President and Head of Global Public Policy for MSD; Dr. Kerri Elgar, Senior Policy Analyst at the OECD; and Dr. Ricardo Baptista Leite, Founder & President of the UNITE Parliamentarian Network for Global Health and the evening’s moderator.

Leite painted a complex picture of the current global health landscape. On one hand, he noted, public trust in institutions is eroding. On the other, “too many political actors… are proactively contributing to misinformation and are provoking what I would call intentional disruption.”

He went on to explain that defense spending now dominates the priorities of many governments—diverting critical resources away from health. This shift, he warned, puts low- and middle-income countries at heightened risk, as their health systems often depend not just on funding but on infrastructure and support from international partners—many of whom are now pulling out.

“The United States is the main actor cutting off without giving an opportunity for transition. And this has devastating effects,” Leite said. “When we look at that, the ripple effects will mean millions of lives will be disrupted, lives will be lost in this process.”

Leite called for an immediate rethinking of global health funding models, urging innovative and inclusive approaches.

“We have to have all hands on deck and find how we do that,” he said. “Unusual actors that haven’t been stepping up, now we have to find them and bring them on board, and we have to have more of a collaborative effort to redesign the way we deliver health and care altogether.”

He also criticized the “broken disease model” of today, warning that it is not fit for the future. Without sustainable investment in health systems, he said, the world is headed toward a two-tiered reality where the wealthy receive care, and the rest are left behind.

“That’s not the world any of us wants,” Leite said.

Alternative health financing channels

This conversation is not new, but the urgency around health funding has escalated due to the budget cuts implemented this year. Elgar noted that many global actors have been calling for alternative channels for external health financing for some time.

In addition, the healthcare funding dialogue needs to be reframed to focus on prevention and view healthcare as a sound investment rather than a liability or budgetary burden, said Krishnamoorthy.

“We have to take a step back and think: We are on the verge with research and development to find some of the most amazing cures and ways that we can live longer, fuller, healthier lives,” Krishnamoorthy said.

“That is so exciting, but I think we understand in the private sector that that’s only the first step. It’s a tough first step, but you have to make sure individuals have access to these medicines and vaccines.”

Krishnamoorthy highlighted that if, in 2025, the world adequately funded the top five non-communicable diseases (NCDs), by 2030 the global economy could save $47 trillion—roughly 20 times the current global health budget.

“We don’t usually think of it like that,” she said, offering a relatable comparison to car maintenance.

“Would you ever take a car out of a lot? Drive it but not get the oil changed, never get your tires turned, never change the filters until the engine just freezes up and you throw it out?” Krishnamoorthy asked.

She argued that too many national healthcare payment systems are structured in exactly that way.

“IFPMA commissioned an analysis that showed that adult immunization programs yield up to a 19 to one return on investment. So you know, these are some basic things,” she said.

Spending to save

To encourage governments to invest more in healthcare, the economic case must be made demonstrating the potential returns on investment that can be achieved through better policies, smarter spending, and prioritizing value for money, explained Elgar.

“It’s not just what you might spend in general, it’s what you might spend to save,” she said. “Increased investment in patient safety, for example, can reduce diagnostic error by around half and represent a direct cost saving of almost 8% in health budgets, which is huge.

“Efficient use of digital tools, including AI, are expected to improve productivity by five percent to 10% and then for every dollar invested in AMR [antimicrobial resistance] for example, and the intervention packages for AMR, the rate of return is $10.

“These are the sorts of arguments that appeal to finance ministers,” Elgar continued.

However, Leite acknowledged that some responsibility lies with policymakers themselves.

He said many parliaments have “gone too lazy” and stopped exploring innovative models of healthcare financing—particularly those that incentivize long-term health and well-being rather than short-term fixes.

IFPMA Director-General David Reddy
IFPMA Director-General David Reddy

To move forward, Reddy stressed the importance of maintaining open dialogue and collaboration.

“Effectively, we’re a family… But in times of crisis, families pull together—and that’s what we need to do at this time,” he said.

Image Credits: Maayan Hoffman, Joy Corthesy, IFPMA.