The fight against malaria is facing a new and urgent challenge as climate change and extreme weather events threaten to undermine decades of progress, according to warnings from several countries at the 77th World Health Assembly this week.

“Recent extreme weather events such as flooding in Malawi and other countries have intensified malaria transmission, disproportionately affecting vulnerable populations,” Dr. Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, told the assembly on Thursday.

France, a leader in the fight against malaria, expressed concern over the lack of funding for malaria response and called for integrating anti-malaria efforts into national health plans, emphasizing that the need for funding has become more urgent as climate change is “increasingly impacting health systems and making them more fragile.”

“We wish to highlight the importance of the One Health approach and the key role of community health workers in local surveillance and awareness of malaria,” the delegation said.

The introduction of new malaria-causing parasite species due to climate change is also putting populations at risk, particularly transitory migrant groups, Costa Rica warned. “We believe it’s essential for international bodies to take these variables into account when allocating resources, both for dealing with public health problems and regional and extra-regional migration,” the country’s delegation said.

Colombia echoed those concerns, noting that “rapidly changing ecosystems are increasing vulnerability and giving rise to new malaria transmission dynamics,” a problem compounded by “increasing migration patterns.”

Eliminating Malaria

Despite the challenges, several countries, including Egypt, Ecuador and Malawi, renewed their commitment to eliminating the disease. Papua New Guinea said partnerships had been crucial to its malaria control initiatives, which focus on prevention, diagnosis, treatment and community engagement.

Malawi is implementing a plan to eliminate malaria by 2030, while Cabo Verde recently became malaria-free, joining just 43 countries worldwide to achieve the milestone and be recognized with this certification by the WHO.

The WHO is adopting a multi-faceted strategy to fight malaria, including new guidelines for countries to prioritize interventions in resource-limited settings and a focus on emerging threats like drug resistance, Dr. Jérôme Salomon, the organization’s assistant director-general for universal health coverage, communicable and non-communicable diseases, said Thursday.

Salomon, reflecting on the achievements of malaria-free countries, stated that key strategies to accelerate progress include introducing new tools like a malaria vaccine and ensuring wider access to existing ones.

“Recent extreme weather events such as flooding in Malawi and other countries have intensified malaria transmission, disproportionately affecting vulnerable populations,” Salomon said, emphasizing the urgency of addressing climate change through proactive mitigation, adaptation, and research.

Investments in primary health care are fundamental, he added, as are efforts to address various factors impacting malaria transmission, including inequities, conflicts, migration, the Covid-19 pandemic and climate change.

Although new tools are becoming available to fight malaria, several challenges are limiting their use, especially in Africa, said a representative from Chad, speaking on behalf of the 47 member states of the WHO’s African region. Chief among them, the delegate said, are shortfalls in funding.

In a joint statement, African countries pressed for greater political commitment and self-reliance in the fight against malaria, appealing for more predictable international aid that aligns with their national policies.

Sudan stressed the importance of tackling security issues to enable far-reaching malaria interventions, while Guinea urged partners to keep supporting immunization efforts and help end repeated malaria outbreaks.

Image Credits: WHO.

Rüdiger Krech, Director of Health Promotion at WHO showing examples of nicotine products with toy-like designs created to attract children.

The tobacco industry is deliberately targeting children with nicotine products, using targeted marketing to lure the younger generation into smoking while publicly promoting e-cigarettes as a less harmful alternative for smokers, according to a new report by the World Health Organization (WHO) and STOP, a tobacco industry watchdog.

The report, released ahead of World No-Tobacco Day on May 31, analyzes ways in which tobacco and nicotine companies design products, implement digital marketing campaigns, and shape policy environments to help them addict youth globally.

“The industry is peddling a narrative that denies or underplays youth addiction,” Jorge Alday, Director of STOP at Vital Strategies, told Health Policy Watch. “If we don’t establish a comprehensive approach and work across agencies, the industry will exploit any loophole or any new opportunity to reach young audiences.”

The report accuses the tobacco industry of targeting children and young people with over 16,000 e-cigarette flavours, employing colourful branding, influencer partnerships, and innovative digital marketing tactics, including the Metaverse.

“The Metaverse could eventually become a virtual shop window like physical or e-commerce stores,” Alday told Health Policy Watch about how the tobacco industry is using new digital forms of marketing.

The tobacco industry is attempting to “replace tobacco users lost to death and disease with a fresh wave of users trapped in addiction,” said Rüdiger Krech, WHO’s Director of Health Promotion, during the report’s launch press conference.

“We see tobacco products taking the shape of chocolates and sweets, candy, taking the form of toys,” Given Kapolyo, the global youth ambassador of the year and an anti-tobacco activist, told reporters. “They’re going out of their way to ensure that they make this product seem very cool.”

The tobacco industry bombards youth with branding, Kapolyo added, targeting areas close to schools, along routes used by young people, and in the digital space.

“These industries are actively targeting schools, children and young people with new products that are essentially a candy-flavoured trap,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General, commenting on the youth-targeting strategies of tobacco firms. “How can they talk about harm reduction when they are marketing these dangerous, highly addictive products to children?”

Fewer smokers, more vapes

Christian Lindmeier, WHO’s Spokesperson and Rüdiger Krech, Director of WHO Health Promotion during a press conference launching a report on tobacco firms targeting children in their marketing

While the global number of smokers is declining, with one in five adults smoking in 2020 compared to one in three in 2000, eight million people still die annually because of tobacco use.

The number of e-cigarette users, meanwhile, is growing, especially among the youngest generation. Globally, 37 million children aged 13–15 years use tobacco, and in many countries, vaping is more popular than traditional cigarettes among adolescents. In the WHO European Region, one in five 15-year-olds surveyed reported using e-cigarettes in the past month.

The tobacco industry often frames vaping as a way to reduce the harmful health effects of carcinogenic substances present in cigarettes, but research shows e-cigarette use actually increases conventional cigarette use nearly three times, according to the WHO.

The US Food and Drug Administration says that nicotine-mimicking substances used in vapes to avoid product regulation can be even more addictive than normal nicotine, Reuters reported.

Curbing the industry’s influence

Introducing tobacco taxes in New Zealand successfully lowered the cigarette consumption, also among the youth

Controlling marketing strategies, including digital ones, is an important way to limit tobacco firms’ influence on youth, the report’s authors said.

“How we define terms like advertising, promotion and sponsorship set the stage for what can be regulated now and in the future. This means that regulators should update rules to cover any and all platforms – physical and virtual,” Alday told Health Policy Watch.

Alday cited the recent example of Nigeria, which announced new regulations that will require health warnings for films that contain tobacco imagery. The regulation covers movies, music videos and skits produced in Nollywood, one of the world’s biggest movie industries, Alday said.

The WHO recommends not only a ban on marketing, advertising, and promotion but also creating 100% smoke-free indoor public places, banning flavoured e-cigarettes, and imposing higher taxes, among other strategies.

The latter strategy has shown significant results, as Vital Strategies’ Jeffrey Drope, co-author of the Tobacco Atlas, demonstrated during the State of Tobacco Control press briefing on May 21.

“Raising taxes [is] arguably the most effective and most straightforward solution,” said Drope. With higher prices, “young people don’t start to use tobacco products [and] people who already smoke or use tobacco stop, or cut down.”

New Zealand’s tax policy effectively drove down youth smoking prevalence as prices doubled between 2009 and 2019. It was also able to make a step towards bridging societal gaps between the general and Maori smoking populations.

The UK’s total ban on cigarettes for people born after 2009 is another example of an ambitious health policy, aiming to gradually raise the minimum age required for buying cigarettes until eventually, they become illegal. The regulation law passed its second reading in April, but has been postponed until after the general elections, BBC reported.  The bill has support from the opposition Labour party, a likely winner of the vote, which gives it much chance to be passed in the next term.

“This really has an enormous effect on consumption,” Drope said.

In their closing remarks, speakers at the press conference emphasized the essential role of youth leaders in shaping the future of global tobacco consumption and policy. “Youth leaders have a key role to play in communicating their reality to policymakers, that use of nicotine products is growing rapidly and these products are harming youth, now,” Alday told Health Policy Watch.

“What young people have is … they have each other,” Kapolyo added. “When young voices unite, even governments listen.”

Gavi, the Vaccine Alliance, addresses countries at the 77th World Health Assembly.

At the 77th World Health Assembly, Gavi, The Vaccine Alliance, urged nations to prioritize vaccinating “zero-dose” children, particularly those in regions affected by humanitarian crises and complex emergencies. These children have not received any shots, putting them at a higher risk of preventable diseases.

“We are scaling up routine immunization and reaching the estimated 14.3 million zero-dose children worldwide, recognizing that most polio cases are in subnational areas with the highest proportion of unvaccinated and under-vaccinated children,” Gavi representatives told the assembly.

Gavi’s 2021-2025 strategy focuses on reaching zero-dose children and missed communities who have not received any vaccinations. The organization aims to reduce the number of zero-dose children by 25% by 2025 and by 50% by 2030.

The World Health Organization reported a decline in the number of zero-dose children from 18.1 million in 2021 to 14.3 million in 2022, nearing the pre-pandemic level of 12.9 million in 2019. The percentage of children receiving their first dose of the measles vaccine increased from 81% in 2021 to 83% in 2022, still falling short of the 86% achieved in 2019.

During Committee A’s discussion on poliomyelitis, Gavi called on member states to integrate polio funding into existing national health systems to promote and accelerate essential polio and broader immunization functions.

Progress and challenges in the Eastern Mediterranean

Dr Hanan Balkhy, WHO Regional Director for the Eastern Mediterranean, highlighted the region’s progress in ending poliovirus transmission but noted that the poliovirus persists in mobile, border, and migrant populations.

“To end polio, we must reach all children, keep strengthening surveillance, address community resistance and disinformation, and continue leveraging polio resources as we build a resilient health workforce across our region,” Balkhy said.

Iraq and Libya have taken full financial responsibility for sustaining polio essential functions, demonstrating what can be achieved when countries commit to transition. In Yemen, the WHO is negotiating with northern authorities to stop outbreaks of polio and other vaccine-preventable diseases this year.

Global efforts and country commitments

Australia pledged $43.5 million to bolster the Polio Eradication Strategy (2022-2026), underscoring the urgency to ramp up efforts to halt vaccine-derived transmission and concentrate on critical regions. The nation also backed routine immunization, emphasizing the importance of partnering with WHO, UNICEF, and Gavi to expedite advancements in achieving the Immunization Agenda 2030 objectives.

Countries spanning the globe, from Sudan and Chad to Guinea, Senegal, Pakistan, India, the Philippines, Kenya, Bangladesh, and Morocco, shared their initiatives, obstacles, and advancements in the fight against polio. All stressed the importance of integrated strategies, community involvement, targeting zero-dose children, and fortifying immunization systems.

African member states, having ended the wild poliovirus outbreak, remain uneasy about polio’s persistent status as a public health emergency of international concern. avi noted that “the 47 countries remain concerned by the ongoing transmission of circulatory poliovirus and by the low level of vaccination in areas that are difficult to access.” Vaccine supply problems and financial limitations were partly to blame for the type two poliomyelitis outbreaks.

African nations have started transition planning for poliomyelitis and post-certification activities, prioritizing indicators for monitoring and evaluation to uphold program quality. However, unstable health systems, coupled with political and economic challenges, may slow down several countries in the region from assuming complete technical and financial responsibility for all polio eradication functions.

United for Self-Care Coalition hosts a WHA side-event in Geneva.
United for Self-Care Coalition hosts a WHA side-event in Geneva.

Costa Rica’s and Malawi’s ministers of health, along with global health and policy experts, gathered in Geneva to discuss self-care.

At an event organized by the Global Self-Care Federation (GSCF), participants advocated for a World Health Organization (WHO) resolution on self-care. Costa Rica, Egypt, and Malawi, the three countries that co-hosted the event, are working to elevate self-care.

Ministerial representatives from Guatemala, Belize, Panama and El Salvador were also in attendance.

“The potentials for self-care are enormous,” Iain Chapple, Professor of Periodontology at the University of Birmingham and one of the summit’s panelists, told Health Policy Watch. However, he said the approach “needs to be multidimensional,” with collaboration from different fields.

“We need self-care embedded in public health policy,” said GSCF Director-General, Judy Stenmark. She explained that a WHO resolution “could lead to meaningful policy change” and cost-savings for healthcare systems.

“We want to save time and money for individuals, healthcare professionals and healthcare systems, and we have the evidence and data that demonstrates that self-care can do all that,” Stenmark said.

According to a policy brief published by the United for Self-Care Coalition, implementing self-care protocols can generate as much as $119 billion annually in savings for health systems.

The WHO estimates that there will be a global shortage of 18 million health workers by 2030. In 2022, WHO said at least 400 million people worldwide lacked access to the most essential health services. The organization put self-care among “the most promising and exciting approaches to improve health and well-being.”

One key aspect of the conversation this week was making self-care accessible to all. Every year, 100 million people are plunged into poverty because of high healthcare expenses, WHO has said.

“A comprehensive approach to self-care should encompass cultural sensitivities, holistic practices and community engagement,” said Wendy Olayiwola, president of the Nigerian Nurses Association UK and Professional Midwifery Advocate.

Self-care can complement other public health services by being integrated into general health coverage plans, especially for people who “fall through the cracks” of the system, said Dr Manjulaa Narasimhan, WHO’s Sexual and Reproductive Health and Research Unit head.

She said that making menstrual products more available across different contexts is a powerful example of self-care implementation.

“Self-care is about how people lead their lives and can care for themselves,” Narasimhan said.

Dr Mary Munive Angermüller, Vice President of Costa Rica and Minister of Health added: “Self-care is not an individual action, it requires a confluence of different circumstances from health literacy to public health policy, in order to realise its potential.”

Putting People at the Center

Another “concrete” benefit of self-care is that “patients take an active role in their health,” said another summit panelist, Ellos Lodzeni, Chair of the International Alliance of Patients’ Organisation. He said patients also make more informed decisions.

“When we put people in the center of healthcare, self-care is inherent,” added Narasimhan.

A big focus of the Global Self-Care Federation’s efforts is education.

Educating people about ways to take care of their health and new tools that can help them with it brings many advantages, said Chapple, who spoke with Health Policy Watch.

Moreover, Narasimhan said that education about where to find accurate health information is essential. She said that sometimes people can find false information online, for example. She said it would be better to provide “good education on self-care, starting from the very beginning.” This means across the life course from the prenatal stage to older adulthood.

Benefits of Self-Care

Various benefits of improved self-care enumerated in the WHO guidelines
Various benefits of improved self-care enumerated in the WHO guidelines

“Self-care can also be discussed in the context of health insurance,” said Dr Mariam Jashi, Chair of the Eastern Europe and Central Asia chapters of UNITE, an international consortium of present and ex-parliamentarians.

She spoke to Health Policy Watch. She said she sees much potential for policy-making regarding health coverage and prevention as essential components of self-care. Screening, for instance, for breast cancer, is “a classic example of self-care. It makes it possible to identify potentially deadly diseases with timely detection [and] increase the chance of survival and quality of life.”

Yet Jashi said we need to agree, “specifically on the international level,” about defining self-care. The summit was an excellent start, Jashi said, “but more work is needed for better framing.”

To find out more about self-care and the work of the United Self-Care Coalition, visit www.unitedforselfcare.org.

Image Credits: Zuzanna Stawiska, World Health Organization.

Wellcome Trust CEO John-Arne Røttingen and Africa CDC executive director Dr Jean Kaseya

GENEVA – For two years, the family of a soldier in the DRC army could not trace him until they discovered that he had been imprisoned – not for doing anything wrong but because he had a mental illness.

“When we speak of disorders, we forget these affect human beings. People who need to be in hospital should not end up in prison,” said the soldier’s brother, Dr Jean Kaseya, the executive director of Africa Centres for Disease Control and Prevention (Africa CDC).

Kaseya spoke at the launch of an African mental health leadership programme to establish a cohort of mental health advocates across the continent, held on the sidelines of the World Health Assembly in Geneva this week. Supported by Wellcome Trust, the goal of the initiative is to train leaders in the health sector to understand and address mental health “through a public health and human rights lens”.

Although the program cannot help Kaseya’s brother, who died soon after his family found him in 2020, it hopes to benefit some of the estimated 120 million Africans struggling with mental health.

Mental health is the stepchild of health programmes on the African continent, receiving just 2% of health budgets. This neglect is reflected in the significantly lower annual outpatient mental health visits in Africa, with only 14 per 100,000 people, compared to the global average of 1,051 per 100,000.

The result of this lack of investment is a vast shortage of mental health workers – 1.4 for every 100,000 people compared to the global average of 9 per 100,000.

Burkina Faso, for example, has only 12 psychologists.

Outdated policies

Cabo Verde Health Minister Filomena Gonçalves

“Mental health policies in Africa are mostly outdated and poorly implemented,” Kaseya told the launch, attended by several African health ministers including those from Burkina Faso, Burundi and Cabo Verde.

“This programme will create a cohort of leaders who understand and can advocate for context-specific, evidence-based approaches to mental health in their countries,” said Wellcome Trust CEO John-Arne Røttingen.

Wellcome’s mental health programme, which has funded numerous African mental health research projects and initiatives, concentrates on anxiety, depression, and psychosis. Røttingen stressed that an integrated approach, with scientists working hand-in-hand with policymakers, is essential to ensure research addresses the right questions and breakthroughs are implemented when tackling these conditions.

“That’s why we are so excited to be working with Africa CDC on this programme,” Røttingen said. 

Cross-sectoral, human rights approach

The World Health Organization’s (WHO) Mark van Ommeren told the launch that effectively addressing mental health required cross-sectoral collaboration across different departments.

Addressing suicide, he explained, means engaging with the Department of Justice for gun control and Agriculture to restrict access to hazardous pesticides that are banned in many countries but still available on the continent, and education to ensure young people have life skills to cope with life challenges.

David Bainbridge and Michael Njenga from CBM Global

David Bainbridge, the executive director of CBM Global, an international organisation that advocates for the involvement of people with disabilities, said the programme could “make a significant impact not only on the wide treatment gap in access to mental health services but also to apply good public health practice to reduce the drivers of mental health conditions and the negative impact on well being.”

“We underscore the need to take a human rights approach to mental health which means that, in addition to the personal suffering that results from experience of mental health symptoms, we’re particularly concerned about the experiences of stigma, social exclusion and abuse experienced by people affected. You’re often denied access to basic rights like family life, livelihoods, even personal autonomy and freedom,” explained Bainbridge.

Michael Njenga, the Africa co-ordinator for CBM Global, said the inclusion of people with lived experience of mental illness in policy making was critical for successful implementation.

Some countries barred those with mental illness from voting or standing for office, while Kenya classified a suicide attempt as a “misdemeanour”, added Njenga.

The closing panel of the Diagnostics Day. From left to right: Dr Sanjay Sarin
Access division Vice-President, FIND, Dr Fatim Cham-Jallow Technical Advice and Partnerships Department at The Global Fund, Renuka Gadde, Senior Advisor of the Clinton Health Access Initiative, Dr Daniel Townsend, Global Fund Advocates Network and Jan Willem Scheijgrond of the Global Diagnostic Imaging Healthcare IT and Radiation Therapy Trade Association

A new generation of portable molecular testing devices unveiled by the global non-profit FIND on Thursday has achieved accuracy levels previously only attainable in lab testing, a potential game-changer for healthcare in regions with limited access to clinics. 

These compact devices can test for multiple diseases using cartridges that analyze tissue, blood, or other bodily fluid samples to detect the presence of molecules characteristic of a particular illness. The devices can perform tests like the polymerase chain reaction (PCR) test, used for diagnosing COVID-19, influenza, HIV, and Ebola. 

“With these innovations, it’s not necessarily the patients that need to go to the clinic,” said Sara Fröjdö, Senior Technology Officer at FIND. “It’s testing that goes to the patients.”

With shortened development times that cut PCR test times from 60-90 minutes to just 15-30 minutes, patients could receive their results during the same consultation, Fröjdö added.

”All of that is made possible, and still with maintained performance, Fröjdö said. “You can really diagnose the patients where they are, not just screen to then send them to a hospital,” 

While these innovations offer convenience for healthcare systems with a dense network of local facilities, they have the potential to revolutionize access to lab-quality testing in rural regions. In 2020, nearly 9% of the global population lived more than an hour away from their closest healthcare centre by motorized transport, according to Nature Medicine. When considering on-foot travel time, this number skyrockets to 3.16 billion, or 43.3% of the world’s population.

Distance to the nearest healthcare facility with access to a motorised vehicle. Gaps in accessible healthcare clearly visible in many remote areas.

However, the technology still faces hurdles to being truly accessible. Commute time is only one of the many barriers to healthcare access, with others including difficulties in securing transportation and lengthy waiting periods before seeing a doctor.

Affordability remains a key challenge. Test cartridges cost approximately €100, with an additional €5-6 per test. FIND scientists say they are carefully designing cartridges to balance affordability, reliability, and ease of use in remote areas.

Manufacturers  must also address cold chain limitations, which hindered low- and middle-income countries’ access to mRNA vaccines favored by wealthy nations.

“[You need] to ensure you don’t end up having a small device that can be really useful in an outreach setting but you need to store it in -20°C,” Ms. Fröjdö said.

Shortened development times also contribute to the cost-effectiveness of this new technology, as the cost per patient decreases when a large number of tests are conducted.

“The product becomes n-times more efficient,” said Jan Willem Scheijgrond from the Global Diagnostic Imaging Healthcare IT and Radiation Therapy Trade Association. “The cost per patient drops suddenly by 90%.”

While the upgraded cartridges are being used in several countries, including the United States, India, and China, manufacturers are looking to extend their reach to serve a larger number of patients and a larger market.

“It’s difficult to put ‘a small lab’ inside, but also be mindful of keeping the price affordable in low- and middle-income countries,” Fröjdö said.

WHO is advocating for improving access to Universal Healthcare to improve maternal and child health.

The World Health Organization’s 77th World Health Assembly passed a resolution on Wednesday calling on countries to bolster maternal and child health by expanding universal healthcare and strengthening primary healthcare, as progress in reducing maternal and child deaths has stagnated globally.

The resolution, led by Somalia, commits countries to tackle the leading causes of maternal and child deaths, particularly in the hardest-hit nations. They agreed to improve access to maternal, sexual, reproductive and comprehensive child health services through stronger primary healthcare and expand access to emergency services, including urgent obstetric care and units for small and sick newborns.

“The political will has been expressed, now the focus must be on implementation by countries and the technical support WHO provides in the context of universal health coverage,” said Dr. Flavia Bustreo, Governance and Ethical Committee Chair at PMNCH, a global alliance for women’s, children’s and adolescents’ rights. “We cannot accept preventable and treatable causes claiming women’s lives.”

Maternal mortality rates stagnated in 131 countries and increased in 17 between 2016 and 2020, putting over 80% of nations on track to miss the Sustainable Development Goals’ target of reducing maternal deaths to under 70 per 100,000 live births by 2030. Gains in newborn and child survival have also slowed.

To meet the Sustainable Development Goals, the world must accelerate progress on reducing maternal mortality by a staggering nine times and slash newborn and under-five mortality by a factor of four, according to the WHO.  

“Prioritizing women’s and children’s health is crucial. This requires increased leadership, commitment and investment in all levels of maternal, neonatal, child and adolescent health. To accelerate progress future strategies to address inequality ensuring no one is left behind,” said a representative for Saima Wazed, WHO Regional Director for South-East Asia, during the discussions.

What the countries have agreed to do

The WHA resolution marks the WHO’s first significant action on maternal mortality in nearly a decade, following the adoption of the Global Strategy for Women’s, Children’s and Adolescents’ Health in 2015. The resolution emphasizes the need for well-stocked facilities, trained health workers, safe water and sanitation, and comprehensive sexual and reproductive healthcare services.

Discussions before the vote focused on improving care quality, leveraging technology and strengthening primary healthcare. The UK highlighted the need to address adolescent pregnancies, unsafe abortions and the growing impact of climate change.

“Political leadership is critical to accelerate progress on maternal, newborn and child health,” said Margot Nauleau, Health and Nutrition Senior Advocacy Advisor from Save the Children. “Now we need to see this resolution translated into action at national and local levels with increased investments and effective interventions to improve health outcomes for women and children,” she added.

WHO’s new resolution commits to tackling the leading causes of maternal and child deaths.

China makes progress, quality of care a concern for India

The global effort to reduce maternal mortality is marked by wide disparities, with some countries making significant progress while others struggle to keep pace. China, recently surpassed by India as the world’s most populous nation, has already met the 2030 Sustainable Development Goals (SDG) targets for maternal mortality.

“Since 2009, China has been providing systematic care to all pregnant women and newborns. In 2023, China’s maternal mortality decreased to 15.1 per 100,000,” a Chinese representative said.

India, despite reducing its maternal mortality ratio (MMR) from 130 in 2015-16 to 97 per 100,000 live births, remains far from the SDG targets. Given India’s population size, its progress significantly impacts global figures. The country maintained at the WHA that it is on track, but the quality of care remains poor, particularly for women from rural, impoverished, and marginalized communities.

African countries, which bear a disproportionate burden of maternal deaths, highlighted the challenges of improving care amidst humanitarian crises.

“Maternal mortality is especially high in fragile, conflict-affected, and vulnerable settings,” said the Ethiopian representative whose country co-sponsored the resolution. She noted that Africa’s maternal mortality ratio remains the highest worldwide, accounting for roughly 66% of maternal deaths in 2020.

Humanitarian crises and increasingly frequent extreme weather events tied to climate change are pushing fragile health systems to the brink, and taking a heavy toll on maternal and child health globally as a result, according to the WHO. Despite the challenges, African nations reaffirmed their commitment to improving maternal health.

“This is an absolute priority for our government. Senegal is committed to addressing more causes of neonatal, child, and maternal mortality,” the country’s representative said. “We’ve strengthened our health system to deal with this issue, and we need accountability to achieve these goals.”

Additional inputs from Elaine Ruth Fletcher

Image Credits: Twitter, Twitter.

A woman carries supplies through a flooded street in Haiti.

GENEVA – A resolution aimed at strengthening countries’ capacity to deal with “natural hazards” faced unexpected opposition over gender-related terminology at the World Health Assembly (WHA) on Thursday.

This is despite the urgency of countries adapting their health services to address extreme weather events, which are becoming more common globally thanks to climate change.

The resolution, proposed by 50 countries from all regions, sought to ensure that countries can provide essential health services, including primary healthcare, surgical and anaesthesia services, sexual and reproductive health, and gender-based violence services, during and after natural disasters.

It also urged the WHO Director-General to provide technical guidance and support to member states, upon request, to “strengthen sustainable local, subnational, national, and regional capacities for gender- and age-responsive, and disability-inclusive health emergency preparedness and response”.

However, a last-minute amendment proposed by the conservative alliance of Egypt, Nigeria, Russia, and Saudi Arabia attempted to replace the term “gender-responsive” with “taking into account gender equality considerations and different needs.” The amendment was defeated in a vote, with 27 in favor and 67 against, with nine abstentions and 75 absent.

When the original resolution was put to the WHA, it passed by 76 votes to eight, with 15 abstentions and 78 absent. The eight countries voted against the term “gender-responsive.”

Following the vote, several countries spoke strongly in support of addressing the unequal impacts of disasters on women and girls, emphasizing that “gender-responsive” is an established term in international language with a clear definition.

Earlier in the day, during discussions on universal health coverage (UHC), various countries stressed the importance of including sexual and reproductive health (SRH) services as an essential part of UHC.

US Health and Human Services Secretary Xavier Becerra specifically noted that SRH services should include those for LGBTQI+ communities, highlighting one of the most contentious issues in the ongoing gender-based debates across nearly all UN agencies, including the WHO.

Image Credits: IFRC, Logan Abassi UN/MINUSTAH.

WHO member states applaud following late-night approval of WHA resolution on Climate Change and Health

WHO member states approved the first resolution on climate and health to come before the World Health Assembly in 16 years – even as 50°C temperatures in Delhi, flooding in southern Brazil and devastating Caribbean storms are driving home the message to more and more countries that climate change is real.

In several hours of late-night debate, states large and small, landlocked and ocean-bound, described in painful detail, their efforts to cope with growing trends of climate-triggered storms and drought, sea level rise, and food insecurity – all leading to more deaths and disability from noncommunicable diseases (NCDs), health emergencies, vector-borne diseases as well as mental health impacts. 

Developing countries along with rich nations also detailed new plans to promote greener health systems and climate-smart food production, ban single-use plastics, and better manage urban waste and other forms of environmental contamination – noting their deep inter-relationship with climate action. 

Shift from ‘adaptation’ to low-carbon health systems and intersectoral action

Traffic jam in Dhaka (Bangladesh) – Fossil fuel burning, including for transport, exacerbates climate change as well as air pollution that kills millions every year.

Whereas the last resolution adopted by the WHA in 2008 focused mostly on health sector “adaptation” to climate change, the new resolution carves out a much broader and more proactive roll for member states and their health sectors in efforts to shape future trends as well as respond to the inevitable.  Among the measures, it urges member states to commit to:

  • “Decarbonization” and “environmentally sustainable health systems, facilities and supply chains;” including consumption, procurement, transport, and disposal of water, energy, food and waste, as well as medical supplies, equipment, pharmaceuticals and chemicals, “with a view to lower greenhouse gas emissions,” without compromising health care provision and quality;
  • Multisectoral cooperation between national health ministries and other national authorities on environment, the economy, health, nutrition and sustainable development, “for a coherent and holistic approach to building resilience and addressing the root causes of climate change;”
  • Resource mobilization, including funding from multilateral development banks, climate funds, health funds and “innovative sources”;
  • Awareness among the public and health sector on the interdependence between climate change and health, “engagement in the development of climate and health policies, fostering recognition of health co-benefits and sustainable behaviour.”

“The very survival of our species will depend on this,” said Colombia’s delegate during a late evening debate over the draft resolution, to which over three dozen countries signed on as co-sponsors. He deplored the dearth of climate finance for developing nations which have contributed the least to the climate problem.

Colombia: ”The very survival of our species depends on this.”

“Sadly, climate ambition is still not supported with adequate and sufficient finance to respond to the huge needs of this crisis. Every year, finance gutters growing to the tune of billions of dollars, we’re not seeing a clear path to a tangible solution,” he said. 

Broad mandate – but still silent on core issues

The words “fossil fuels” or even “clean energy” don’t appear in the text – something civil society groups such as the World Heart Federation and some member states, including The Netherlands,  which co-sponsored the resolution along with Peru, lamented. 

Even so, the Dutch delegate expressed hope that WHO’s example of achieving net zero in its own operations – a feature of WHO’s new four-year strategy (2025-2028), would inspire member states to do the same, saying:  

“The Netherlands believes transitioning away from fossil fuels is a public health imperative and hopes the new WHO roadmap to net zero will inspire member states to follow suit.”

Extreme weather driving awareness

Mexico’s delegate describes how extreme weather has sensitized Mexicans to the “urgency” of climate action.

Despite such gaps in the text, nation after nation talked about how the reality of the devastating effects of extreme weather and sea level rise is driving more awareness of the need to act. 

That included small island states, such as Jamaica, and the Dominican Republic, and larger nations, from Pakistan to upper-income Mexico and high-income New Zealand. 

“Our delegation would like to approach this matter with a sense of urgency given the effects of the climate crisis that we’re living through,” Mexico said. “According to the World Meteorological Organization, Mexico had the weather event with the highest economic losses during 2023 – hurricane Otis,” she added, noting that in recent weeks, the country has now been facing a severe heatwave. 

“Climate change undermines the very foundations of our societies, threatening the security of our food systems and the safety of our homes and livelihoods. small island developing states including our sisters and brothers in the Pacific face threats to their very existence,” said New Zealand.

Clean and green healthcare 

Workers affix solar panels to roof of a new hospital in Alberton, South Africa. Opened in 2022, it features natural lighting, on-site grey water treatment and recycling.

Member states from the United Kingdom to Indonesia also applauded the resolution’s strong stance on advancing clean and greener health care – including through the new WHO Alliance for Transformative Action on Climate and Health (ATACH). 

Launched at the UN Climate Conference (COP 26) in Glasgow in 2021, nearly 100 member states have joined the initiative, which promotes climate resilient health facilities – through knowledge exchange and voluntary country commitments to a stepwise set of low-carbon and, ultimately, net-zero targets.

“Indonesia is in the process of integrating a performance indicator on climate resilience and health facilities in the health sector master plan – meaning net zero emissions in health facilities by 2030,” said one delegate, describing the country’s plans and progress. She called upon WHO to support member states in accessing investments from the Green Climate Fund “and other financing mechanism dedicated to climate and health for promoting the implementation of green hospitals.” 

One Health, ecosystems and climate-smart agriculture

Ethiopia’s initiative has made tree planting a culture among Ethiopians, with more than 30 million people taking part every year during the summer rainy season,

Delegates’ statements also reflected an  increasingly nuanced understanding of the interlinkages between climate stability, biodiversity, sustainable food production and health. 

One Health – an issue that has become a volleyball in the pandemic agreement talks between rich and poor countries – even received a positive reference mention in the climate and health resolution – which a numbe of developing countries underlined as important.

“It’s important to bear in mind the importance of the One Health approach in the climate and health work,” said Colombia,”in particular, given the needs of protecting vital vital ecosystems like the Amazon, which is the most biodiverse ecosystem in the world –  and that plays a key role in climate in global health. “

Said Mexico, “climate justice for small scale farmers must also be coupled with the transformation of the food system”. She referred to the country’s ban on farm chemicals like glyphosate, as well as genetically modified corn. The Mexican moves have been hotly opposed by agribusness. But critics say both the GMO corn and glyphosate, a pesticide, have knock-on consequences for ecosystems, human health, livelhioods and sustainable food production.  

Ethiopia, meanwhile, is planting billions of trees to combat deforestation, soil erosion and flooding. The initiative has made tree planting a national past-time – although some critics have said it  needs better planning. In parallel, the country is promoting more “climate smart agriculture,” to improve nutrition and reduce biodiversity loss; improved urban waste management and electrification of transport. 

But finance remains key, Ethiopia’s delegate also underlined saying: “We urgently need increased international financing, technology transfer and capacity building support to protect our people from the climate.” 

Curbing plastic hazards 

Plastic
Most plastics that are produced end up in landfills, the oceans, and open waste dumps of developing countries.

Plastics pollution was also described as a dangerous blight to health, climate and environment by countries as diverse as Thailand and Tanzania.

The new climate resolution should help measures to “reduce plastic pollution in the health sector”, observed Thailand, adding that the country is also “working to reduce exposure to micro-plastics, which have been found in human food, water, and air – causing oxidative stress, neurotoxicity, and developmental toxicity,” said the country’s WHA delegate, noting a recent ban on single use plastic bags, as well as initiatives to better manage health sector waste, much of it from plastics.

While not specifically mentioned in the climate resolution, most plastics are produced by by products of fossil fuel extraction, as the International Council of Nurses noted in a statement – and therefore the issues are intertwined.

Over the past 30 years, plastics production increased fourfold, with growth rates still rising exponentially

And the fossil fuels industry has ambitious plans to increase plastics production over the next 25 years – compensating for possible slackening of demand in the transport and energy sectors.

UN member states’ are meanwhile also engaged in tough negotiations over a treaty to curb plastic waste – facing off against stiff industry interests. WHO has proposed that it join the global treaty talks, providing expert advice to negotiators, and to a UN Environment Science Policy Panel on chemicals, waste and pollution. The panel is set to convene in Geneva for it’s third meeting from 17-21 June.   

Russia protests WHO offer of health expertise to UN science panel on chemicals, waste and pollution 

Russia’s delegate objects to linking, plastics pollution, health and climate.

The WHO proposal to join the UN Environment Science Panel, as well as member state references to the linkages between health, climate and plastics brought a stiff response from the Russian Federation:

“We’d  like to draw your attention to how inadmissible it is to shift our focus from the issue of the impact on health of climate change – and pollution through plastic waste in order to focus on combating plastic itself,” the Russian delegate stated. “We must ensure an impartial, objective comprehensive comparison of plastic products with products made using alternative materials.”  

“Russia cannot support the idea of WHO providing Secretariat functions for the Science Policy Panel to contribute further to the sound management of chemicals and waste,” the delegate added. . 

He also called for WHO to keep the health care sector out of the center of deliberations over new UN treaty on plastics pollution – despite healthcare’s outsize consumption of single use plastics.

“We do not support the proposal that the main goal of the international treaty on plastic should be the issue of health care,” said the Russian delegate, disassociating the Federation from references to the WHO ATACH initiative on health sector resilience, as well. 

‘Gender equality’  

Prior to it’s approval, the draft climate and health resolution also was the focus of a back door struggle on its references to gender-related language, also led by Russia and other socially conservative  states.  

To reach consensus, references to “‘gender responsive/sensitive’ climate action and health systems” were removed from the final draft. That was in response to critics who said the words could imply recognition of  LGBTQI groups  – whose activities are banned and even criminalized in many countries around the world. 

The final draft saw just one single reference to “action on climate change and health that is more integrated, coherent and advances gender equality, in line with Sustainable Development Goals.”

Even so, the Russian Federation disassociated it from that reference, as well, after the draft was aprpoved, saying that terms like gender in/equalities “does not enjoy agreement.” 

Retorted Belgium, on behalf of the European Union: “We are rolling back on many years of substantial progress on human rights and gender, reducing our ability to mitigate climate change and of WHO to lead effective programs on the ground.” 

Image Credits: Flickr – joiseyshowaa, https://www.netcare.co.za/News-Hub/Articles/environmental-sustainability-at-the-heart-of-new-hospital-design, Tiksa Negeri / Dialogue Earth, Photo by Hermes Rivera on Unsplash, Plastics Atlas, 2019.

Rwandan Health Minister Sabin Nsanzimana, the Heart Foundation’s Trevor Shilton, NCD Alliance CEO Katie Dain and Karen Sealy of the Trinidad and Tobago NCD Alliance.

GENEVA – Just six countries in the world are on track to meet global targets to reduce non-communicable diseases (NCDs), particularly cardiovascular disease (CVD), cancer, chronic respiratory diseases and diabetes.  At the World Health Assembly (WHA) this week, every country – rich and poor – lamented their struggles to contain rising NCDs, which now cause three-quarters of global deaths.

Progress has been made since the last UN High-Level Meeting on NCDs seven years ago, sector leaders said at a sideline meeting organised by the NCD Alliance and the World Heart Federation on Thursday. But with current global NCD targets set to expire in 16 months when the next UN High-Level Meeting on NCDs will be held in New York, the world is “badly off track,” said Dr Bruce Aylward, World Health Organization (WHO) Assistant Director-General on Universal Health Coverage.

Bente Mikkelsen, WHO’s NCD Director, said it is “purely immoral” that only half the estimated 1.3 billion people who have hypertension were aware of their condition, although the diagnosis is simple. Undiagnosed hypertension is a major cause of strokes. While some 42 million people die from NCDs each year, many deaths could be averted with early detection and treatment.

“Four and a half billion people don’t have access to basic services, and two billion people are suffering financial hardship when they try to access life-saving services. This is a catastrophe,” said Aylward. “We can’t solve the NCD problem without financial protection. The poor in our societies need to be able to access medicines and services they need for free and that is a responsibility of governments.”

Expanded definition of NCDs 

In just seven years, the global NCD agenda has seen significant expansion, said Katie Dain, CEO of the NCD Alliance. The definition now firmly includes mental health and neurological conditions, and air pollution is recognized as a key risk factor. WHO’s Mikkelsen added that the links between climate change and NCDs are also now recognized.

Governments are starting to see addressing NCDs as an investment rather than purely an expenditure, with growing country-level leadership and involvement of people living with NCDs, Dain noted.

Rwandan Health Minister Sabin Nsanzimana said his country recently equipped 58,000 community health workers with blood pressure machines, a “very easy and cheap means of diagnostic screening.” Rwanda’s mortality rate began shifting from infectious diseases to NCDs around 2015, prompting the creation of an evidence-based, culturally sensitive NCD plan.

Nsanzimana noted that some lifestyle challenges are rooted in past community practices, making it difficult to encourage people to cut certain foods and drinks that are “strongly rooted in culture and society.”

“You tell people too much milk isn’t healthy, while mothers and grandmothers always said milk is everything,” he explained. Nsanzimana warned countries that not managing NCDs early leads to “complicated treatment” for issues like cardiac arrest and renal failure.

WHO’s Bente Mikkelsen addresses the meeting, alongside Loyce Pace, Ashley Bloomfield and Bruce Aylward.

Building community trust

New Zealand’s Ashley Bloomfield, co-chair of the Working Group on International Health Regulation amendments, also emphasized the importance of building community trust. “We’ve had tremendous success in tobacco control. Our adult daily smoking rate is now under 7%. In the early 2000s, over a third of our indigenous Maori girls aged 14 smoked daily. It’s now 3%,” he said.

Bloomfield added that effective communication to build public trust was a key lesson learned during the pandemic, citing New Zealand’s successful COVID response that minimized deaths and prevented health system overload by “keeping the virus out until we had high vaccination rates.”

“Fundamental to that was building public trust, so people understood the why,” said Bloomfield. “Effective communication to build trust in the population … helped to minimise deaths and prevented our health system from being overwhelmed.” 

Karen Sealey, executive director of the Trinidad and Tobago NCD Alliance, said her group of 13 organizations successfully lobbied for years to establish a health ministry NCD unit. The alliance is now so well trusted that it assisted with the ministry’s pandemic vaccination drive.

Community involvement in health

“Next year’s NCD High-Level Meeting needs to represent a massive step change, with a significant focus on ground-level action and implementation, where the biggest gap is,” Dain said.

Community health system involvement is a timely topic, as the WHA adopted a “social participation” resolution this week.

The resolution urges member states to “implement, strengthen and sustain regular and meaningful social participation in health-related decisions across the system as appropriate, taking into consideration national context and priorities,” and suggests “facilitating capacity strengthening for civil society to enable diverse, equitable, transparent and inclusive social participation.”

Conservative countries targeted this resolution for its use of “gender-responsive,” as reported by Health Policy Watch. In the final resolution, this term was replaced by “gender equality”.