The UN biodiversity summit in Cali yielded welcome decisions on health, Indigenous representation and benefit sharing from genetic sequences but fell short of major questions of finance and implementation.

Nearly 200 nations have backed a groundbreaking global action plan linking health and the natural world at the close of UN biodiversity negotiations in Cali, Colombia, marking a rare victory in a summit otherwise characterised by disappointment.

The final agreement on a “health and biodiversity action plan” was approved as a voluntary rather than mandatory measure, serving as a best-practice guide for nations to integrate health considerations into their nature protection plans. But it still stands as an achievement, capping four years of negotiations and reflecting health’s growing prominence in environmental diplomacy.

“Parties approved a global action plan on biodiversity and health designed to help curb the emergence of zoonotic diseases, prevent non-communicable diseases, and promote sustainable ecosystems,” the COP16 secretariat announced as the Cali meeting closed early on Saturday morning after a frantic overnight session.

“The strategy embraces a holistic ‘one health’ approach that recognises the health of ecosystems, animals and humans as interconnected,” the secreteriat added.

Other key developments from the 16th conference of parties to the Convention on Biodiversity (COP16) included a new voluntary framework whereby a small percentage of corporate profits derived from genetic resources harvested in countries should be allocated to a new global fund for biodiversity protection – dubbed the Cali fund.

Nations also agreed to establish a permanent body for Indigenous peoples within the UN treaty framework following three decades of advocacy on the issue.

Yet the likely legacy of COP16 came in its complete failure to mobilise funds anywhere near the $200bn annual target for nature protection by 2030 set out in the landmark Convention on Biodiversity (CBD) agreement reached in Montreal in 2022. It raised just $163 million in new funds to combat the biodiversity crisis – 500 times short of the 2030 goal.

In a final blow to the summit’s ambitions, nations failed to agree on mechanisms to monitor compliance with the treaty and its targets – this after the world has missed every single UN biodiversity goal since the CBD framework’s establishment in 1992.

Global action plan links health and nature protection

The new UN biodiversity and health action plan urges governments to put health at the heart of their nature protection strategies. While voluntary, the agreement marks a turning point in environmental policy by formally recognising for the first time that “biodiversity loss and its direct drivers are a threat to animal, human and plant health”.

The decision comes as scientists increasingly warn that the destruction of natural habitats is driving disease outbreaks and raising pandemic risks. The loss of biodiversity also undermines Earth’s basic life support systems – from food security and clean water to medicinal plants and vital ecosystem services. These impacts are amplified by the climate crisis, creating a feedback loop that further threatens public health.

Drawing on “lessons” from Covid-19, the plan emphasises the “urgent need to conserve, restore and sustainably use biodiversity” to prevent future zoonotic diseases – those that jump from animals to humans.

‘Embracing the interconnectedness of biodiversity and health’

The decision document places particular emphasis on how vulnerable groups, including women, children, the elderly and people with disabilities face outsized health impacts, while Indigenous communities are especially hard hit,  given their “unique interdependent relationship” with local ecosystems. 

Key rehabilitation strategies outlined in the 21-page health and biodiversity blueprint call on countries to set health-relevant targets that would also help reach the overall targets of the Convention on Biodiversity. These include, for example, the promotion of more healthier and sustainable agriculture, fisheries and forestry; addressing wildlife fragmentation and species management; land and sea use; and reducing pollution in multiple forms, from air pollutants to microplastics.

The text also calls for countries to address the unsafe disposal of antimicrobials and pharmaceuticals – which fuel drug resistance already claiming 1.27 million lives every year and threatening the efficacy of medicines used by billions globally.

“This is a breakthrough moment affecting humans, wildlife and other animals, and ecosystems,” the Wildlife Conservation Society, which provided technical input to the negotiations said in a statement. 

“Millions died and suffered due to the COVID-19 pandemic, and this Convention is charting an excellent path to fully embrace the integration and interconnectedness of biodiversity and health,” WCS vice-president Susan Lieberman added.

“There can be no prevention of future pandemics of zoonotic origin without the protection and ecological integrity of nature,” Lieberman said. “We have no future without nature.”

No binding measures adopted

However, as one of few documents achieving consensus in Cali, the final text emerged somewhat diluted. 

The plan repeatedly emphasizes its voluntary nature, stating that “nothing” in the document “should be interpreted as modifying the rights and obligations” of any nation that is party to the legally binding CBD agreement reached in Montreal in 2022. 

Specific references to industry’s impacts on biodiversity and health were softened. For instance, explicit mention of “unsustainable agricultural intensification” was removed from the final text. Ditto for a blunt reference to the “increasing human demand for animal protein” as a factor driving zoonotic diseases. Instead, the final text notes that  infectious diseases “can be exacerbated by human activities, such as unsustainable land-use change practices and habitat fragmentation.” 

Even so, advocates of a stronger linkage between health and biodiversity said the decision was a step in the right direction. 

“At the end of the day, this plan is only going to be voluntary, but it’s still good guidance,” Dr Colman O’Criodain, head of biodiversity policy at WWF, told Carbon Brief. “Even if countries that don’t commit formally to implement it use the guidance and take the parts of it that are relevant to them, that’s still a good thing.” 

Landmark ‘Cali Fund’ created for companies to share profits from the use of genetic resources 

Another key agreement came in the early hours of Saturday morning, when nations agreed to create a new global biodiversity fund, financed by corporate profits derived from the creation of new products using genetic resources. 

The agreement, which first appeared uncertain amid hundreds of early textual disputes, stood out as a rare note of final consensus in an otherwise divided summit.

At the heart of the new arrangement is the sharing of Digital Sequence Information (DSI) – which can map the unique genetic blueprint of virtually any plant species or micro-organism, including pathogens, at the digital level, making sharing faster and more efficient than through biological tissue samples. 

Big food, cosmetics and pharmaceutical companies worldwide now harness and use genetic resources, captured as DSI, across far-flung borders, to create new products worth billions of dollars annually. But developing countries have long maintained that they are left out of the loop of benefits that come from the harvesting of new genetic resources in their regions. The new plan marks the first global attempt to address the imbalance. 

The agreement targets companies meeting two of three thresholds: annual sales exceeding $50 million, profits over $5 million, or assets above $20 million. These firms “should” contribute either 1% of revenue or 0.1% of profits to the new “Cali Fund” to support developing country biodiversity preservation and restoration. Although the rates remain “indicative”. 

Further underlying that voluntary nature, a last-minute revision stripped out a requirement for companies to “demonstrate” they hadn’t used DSI in their products. 

“The deal reached means businesses have the option of voluntarily contributing to a new fund – known as the Cali Fund – if they use this genetic information from nature, said the UK Government’s Department for Environment, Food and Rural Affairs, calling it a “new deal for biodiversity from using nature’s genetic information”. 

Global patterns of gene sequence data sharing, June-November 2022. The bigger the dot/higher the number, the more DSI data generated by the country was used by researchers elsewhere.

The CBD will manage the funds collected for nature conservation, with at least half flowing to indigenous communities. In that way, the new Cali Fund also aims to avoid the pitfalls of closely attributing the profits from genetic resources culled by industry to one particular country or community. 

“Parties and non-Parties are invited to take administrative, policy or legislative measures, consistent with national legislation, to incentivise contributions from users in their jurisdiction to the global fund in line with the modalities of the multilateral mechanism,” the text urges.   

UN Environment chief Inger Andersen also hailed the mechanism as a “big win” – even if further refinements to the profit-sharing mechanism will have to rely on national interpretation – or next year’s next COP 17.   

“The new ‘Cali Fund,’ although imperfect and with many details still to be ironed out, is an important step forward,” said Kirsten Schuijt, Director General of WWF International. “It ensures that companies profiting from nature contribute fairly to biodiversity conservation and directs critical funding to the people and places that need it most.”

Notably, the United States, home to many leading agro, pharma and cosmetics giants is  not a signatory to the CBD – leaving Washington outside the scope of compliance altogether. 

Pharma voices concerns over impacts on medicines and vaccines R&D 

Inudstry groups from all sectors showed up in full force to the Cali negotiations. / Graph by DeSmog.

Despite its voluntary nature, the new arrangement quickly came under fire from pharma industry voices who expressed fears that the arrangement could hinder the rapid sharing of genetic data on pathogens, critical for new medicines development during health emergencies. 

Pharma has argued that pathogens, unlike genetic resources used to develop new plant products or cosmetics, need to be shared with researchers with no strings attached so as to expedite the development of new vaccines and medicines. Pathogens also  mutate, rapidly crossing borders and making their genetic origins all the more difficult to trace. 

During COVID-19, for instance,  mRNA vaccines by Moderna, Pfizer and BioNTech relied on hundreds of digital genetic sequences to roll out vaccines in record time – generating billions in profits but also saving millions of lives.

“The decision adopted today does not get the balance right between the intended benefits and potential costs to society and science,” warned David Reddy, Director General of IFPMA in a press statement. 

“The pharmaceutical industry has long supported the Convention on Biological Diversity’s objective to protect our natural world,” Reddy said. 

Even so, “The ability to rapidly use scientific data known as “digital sequence information” (DSI) is essential for developing new medicines and vaccines,” he added. “Any new system should not introduce further conditions on how scientists access such data and add to a complex web of regulation, taxation and other obligations for the whole R&D ecosystem – including on academia and biotech companies. 

“Ahead of COP17, it is critical that governments work to ensure the implementation of any new mechanism on digital sequence information does not stifle medical research and innovation that can bring the next wave of medical progress to people around the world.”

Issue is also being debate in WHO-led negotiations on a Pandemic accord  

WHO member states discuss new pandemic convention or treaty, 18 July 2022.

Another complication lies in the fact that a mechanism for linking pharma pathogen access and benefit sharing (PABS) is also being debated in WHO-led member state negotiations over a Pandemic Accord, which resumed on Monday in Geneva. 

Any decision ultimately reached in a Pandemic Accord could potentially supersede the arrangements in the CBD, particularly since the Accord is supposed to be a legally binding agreement.  

Meanwhile, independent experts are still divided over if and how a profit-sharing mechanism could  be designed that did not also hamper rapid vaccine development and outbreak monitoring and reporting by countries. 

The DSI Scientific Network, a global alliance of experts from over 20 countries, has, on the one hand, suggested sales-tax like levies on end products– could balance seamless genetic sequence access for research with profit-sharing. It has also proposed “in-kind” contributions like vaccine doses to ensure equitable access.

Yet charging companies for using particular genetic sequences in their end products – may in fact be much harder than it sounds, the same expert network observes.

“Research that uses DSI routinely compares and selects among millions of sequences, often merging or editing them, making it impossible to attribute products to any single sequence,” DSI Network researchers explained in one brief, which explored Moderna’s COVID-19 vaccine patent application as an example.

“With many nearly identical sequences from different countries, proving which ones were used to develop commercial products becomes unfeasible,” the researchers said. 

Funding shortfalls for biodiversity preservation 

The majority of nations have yet to submit their national biodiversity protection required by the Montreal-Kunming Agreement, but officials say the less than two year deadline – and the incredible complexity of ecosystems like the Amazon, means these plans take time to develop.

While observers say that the new ‘Cali Fund’ for DSI profit sharing could eventually generate up to $1 billion annually for biodiversity protection, reaping those funds is years away. 

And that still falls far short of the target in the legally binding UN biodiversity of 2022.  That  treaty called for $200 billion annually for nature protection by 2030, including $20 billion from rich countries on a voluntary basis. The needs, meanwhile, rise as high as $700 billion annually required to sustainably protect and restore global ecosystems, independent experts have maintained.

Over the two-week run of COP 16, just $163 million from eight countries – including Germany, Austria, France, Norway and the UK – was pledged to the CBD’s ‘Global Biodiversity Framework Fund’ (GBFF), hosted by the World Bank. That brings currently available funding to $400 million – 500 times short of the 2030 target.

After COP 16 stretched into overtime, lasting all night Friday until 9am Saturday morning, the summit was abruptly suspended when too few countries remained in the room for decisions to be made. Many smaller delegations, unable to afford costs to rebook flights, had to leave – an unceremonious end that encapsulates the core frustration expressed by developing nations, scientists and civil society observers alike: where is the money?

Where is the money? 

Originally, funds were expected to come from slashing $500 billion in environmentally harmful subsidies, which the 2022 Montreal CBD agreement had pledged to eliminate. Governments, however, allocated a record-breaking $1.4 trillion to fossil fuel subsidies in 2023. And the World Bank estimates countries spent $1.25 trillion subsidizing agriculture, fossil fuels, chemical production and other industries that destroy biodiversity.

While the EU announced it will double its biodiversity funding to $7 billion for 2021-2027 and committed hundreds of millions to other projects to deliver –”on global financing commitments to protect nature” – a strong push led by the African Group and Brazil to establish a new biodiversity fund was rejected. 

Developing nations had argued that the World Bank-hosted GBFF is too complicated to access and controlled by wealthy countries – an argument rejected by the European Union and other major donors.

Ultimately, the meeting even failed to agree on a budget for the Convention on Biological Diversity itself, the instrument under which the biodiversity COPs are organized. 

Debt crisis sidelined

As developing countries face unprecedented debt burdens, nations argue finance in the issued in the form of debt should not be counted towards nature spending targets.

Host nation Colombia’s also pushed to have the burgeoning debt crisis recognized in financing arrangements – but that too failed to receive support. 

Donor nations in Europe and elsewhere provide the majority of their biodiversity funding as loans – and that trend is accelerating, with about 80% or more of new funding in 2021-2022 coming as loans rather than grants. China – which holds trillions in developing country loans – also opposed recognizing debt as part of the biodiversity crisis.

Last month, the World Bank revealed the world’s 26 poorest countries are in their worst financial shape since 2006, as natural disasters and COVID-19’s reverberating shocks continue to hit their economies. Over 3 billion people now live in nations spending more on debt financing than education and health budgets, according to UN figures. Developing countries trapped under major debt burdens argue loans should not count as finance.

An expert report on debt, nature and climate released just ahead of COP16 meanwhile found that countries most exposed to biodiversity loss and climate-driven extreme weather now rely increasingly on expensive loans to rebuild and cope with changes.

“Emerging markets and developing economies have seen both the levels and cost of debt soar,” the Independent Expert Group reported. “This means that EMDCs can borrow less, at greater cost, at a moment when they need more and cheaper finance to limit the extent of future shocks.”

“It is essential today to change debt for climate action,” Colombia’s President Gustavo Petro said at the opening of COP16. “Those who emit the most CO2 into the atmosphere are the fossil, oil and coal economies, they are the powerful economies of the United States, China and Europe,” and they are the ones who “charge interest rate surcharges to countries that can still absorb CO2.”

“That is a true moral and deadly contradiction,” he said. “It is the richest, predatory countries that must be taxed to eliminate carbon from production and consumption,” he added.

Historic victory for indigenous peoples 

Yet amid the summit’s setbacks, one significant victory emerged: the agreement by nations to establish a permanent body for Indigenous Peoples within the CBD  framework.

The new subsidiary body recognizes “Indigenous Peoples and people of African descent as key protagonists in biodiversity conservation,” providing them with a seat at the table to protect traditional knowledge systems, strengthen representation in decision-making, and promote Indigenous territorial biodiversity management.

It is the first formal mechanism for indigenous communities’ representation within UN environmental negotiating frameworks. 

“This is an unprecedented occasion in the history of multilateral environmental agreements,” said Camila Paz Romero, Indigenous Peoples’ spokesperson at the summit. “Indigenous peoples and local communities of the world – connected from our knowledge systems in the care of life and biodiversity – remember the long road we have travelled towards this agreement.”

Image Credits: COP16, CIFOR-ICRAF, UNCTAD.

INB co-chairs Anne-Claire Amprou and Precious Matsoso, alongside WHO Director-General Dr Tedros Adhanom Ghebreyusus.

The pandemic agreement talks resumed on Monday for two weeks, but parties only have a week to decide whether they have sufficient common ground to call a special World Health Assembly (WHA) in December to adopt the document.

Procedurally, 12 November is the last day by which a December WHA can be called. Negotiators will “stocktake” progress on Friday and decide by next Monday whether to call a December WHA or wait until next year’s regular assembly in May.

Several countries are pushing for a December agreement amid growing geopolitical uncertainties including the imminent US election, and outbreaks of mpox, H5N1 and Marburg.

A Donald Trump victory could mean the US withdrawal from the negotiations and withholding their dues from the World Health Organization (WHO), which Trump did during the COVID-19 pandemic.

US and African negotiators pushed for the December WHA during the opening of the 12th meeting of the intergovernmental negotiating body (INB), while others including stakeholders, cautioned against sacrificing content for speed.

But WHO Director-General Dr Tedros Adhanom Ghebreyesus warned negotiators not to make “the perfect the enemy of the good”, stressing that no party will get all their demands.

“With the proposals on the table, I believe you have the ingredients in place to meet your objective,” Tedros told the INB, which has been negotiating for almost three years.

He also said that reaching agreement would provide hope that, “despite political and ideological differences between countries, we can still come together to find common solutions to common problems”.

Africa, US push for December adoption

Tanzania, speaking for the Africa Group, wants the agreement adopted in December.

“The Africa group is resolute in its ambition to finalise the agreement process by December 2024. This timeline is not arbitrary, but a moral imperative,”  said Tanzania, speaking on behalf of the Africa Group of 48 countries.

For Ethiopia’s Ambassador Tsegab Kebebew Daka, “the outstanding issues are not that many, but are those that require political decisions to ensure whether the language in the current text addresses the shared threat of the next pandemic and the challenges that our countries are facing on the ground”.

US Ambassador Pamela Hamamoto told the INB: “There’s no question that this pandemic agreement will have real-world consequences. The recent declaration of mpox as a public health emergency of international concern (PHEIC) demonstrates just how relevant our work remains. 

“Concluding these negotiations is a priority for the United States, and we seek to facilitate an effective agreement by year-end, if at all possible.”

Hamamoto said that the Friday stock-take was crucial to “carefully assess progress made and accurately identify areas of convergence, as well as issues that will require further discussion before consensus can be reached”. To assist, she appealed to the INB bureau to develop a framework of clear  criteria for member states to consider to make the December call.

US Amabassador Pamela Hamamoto.

At a stakeholder briefing last week, the INB Bureau stressed that they are aiming for a document that can grow in the future – in other words, what commentators have described as a pandemic agreement “lite” that can provide the framework for more detailed plans about contentious issues such as the proposed pathogen access and benefit-sharing (PABS) system.

‘Consensus is the silver bullet’

But many countries advocated caution, including the European Union (EU). EU Ambassador Lotte Knudsen called for “pragmatic solutions that work for all of us” given that “a number of key issues are still outstanding”

“To proceed with calling a special session, we all need to be fully convinced that the agreement will be ready for adoption. This is too important an objective to make any leap of faith that is not properly grounded in tangible progress in the negotiations,” Lotte stressed.

The agreement’s test is whether it will make a substantial difference to improving prevention, preparedness and response on the ground, she added.

“The content will be far more important than the timing of its adoption. Consequently, our top priority remains to achieve a meaningful and impactful agreement that can command large, ideally universal, participation.”

Comparing the agreement to food, Germany’s Bjorn Kummel stressed that negotiators had to ensure that the “dish needs to be tasteful to all of us” for it to be adopted by all 194 member states.

“Consensus is the magic bullet here,” Kummel stressed.

Germany’s Bjorn Kummel.

Equity challenges

Malaysia, on behalf of the 35 countries making up the Equity Group, spelt out the mountain that still needs to be climbed to change the status quo in favour of low and middle-income countries.

The Equity Group’s key concern is how the proposed PABS system ensures that countries sharing information about pathogens with pandemic potential can benefit from vaccines, therapeutics and diagnostics (VTDs) developed as a result.

“We cannot leave all the critical details for the PABS system for the future,” Malaysia noted.

Malaysia, speaking for the Equity Group, outlined some of the shortcomings of the current draft.

The Equity Group’s demands to ensure fair and equitable benefit sharing include a clear link between access and benefit sharing, making 20% of real-time production of VTDs available to LMICs during a pandemic and annual payments for access to PABS by entities that may profit, such as pharmaceutical companies.

Appeal from the coalface

Meanwhile, Rwanda’s Minister of State for Health Dr Yvan Butera said that his country’s outbreak of the deadly Marburg virus shows that the world is “prone to shocks at any time and anywhere”.

When asked by Health Policy Watch whether he had a message for INB negotiators, Butera said “being able to work together collaboratively to handle these situations efficiently” is essential.

“The capacity to be able to prevent, rapidly detect, respond, and deploy innovative tools in terms of prevention, therapeutics and  diagnostics, is extremely important,” said Butera.

“And then sharing the knowledge so that it can shape better policies or better tools to contain and control future diseases that have potential to become outbreaks, epidemics or pandemics.”

Meanwhile, Africa CDC’s lead on mpox, Dr Ngashi Ngongo, stressed that “benefit-sharing really resonates”.

“If you have used the viruses and pathogens from an African country to develop vaccines, it is really common sense that, in the distribution of the medical countermeasures, those that also contributed with the pathogens also get a share,” said Ngongo.

“Perhaps the lines were a bit hard at the first time, but we are hoping, with everything that has gone behind the scenes, that both sides will be able to come to to a compromise.”

WHO EURO Region Committee leadership
WHO European Region leaders and member states met to discuss policies and priorities for the coming years, including a focus on health security and health systems strengthening.

WHO Member States gathered in Doha, Washington, D.C, Copenhagen, Manila, and Brazzaville for their respective World Health Organization (WHO) Regional Committee sessions in the past months to set policies, strategies, and frameworks for the coming years. 

The WHO Regional Committees – the WHO’s governing bodies in each of six regions – meet yearly to formulate regional policies, supervise WHO activities, comment on the regional components of WHO’s budget, and every five years, nominate a regional director. 

On Wednesday, in the final edition of the regional series, the WHO European Regional Committee nominated Dr Hans Henri Kluge as WHO Regional Director for Europe for a second 5-year term, which will begin in February 2025 after his formal re-election by the WHO Executive Board at their January 2025 meeting. 

That followed the nomination of a new Regional Director for WHO’s African Region in late August, where Dr Faustine Engelbert Ndugulile of Tanzania was nominated to take over the helm from Matshidiso Moeti, Africa’s first female RD, who served ten years in the position. The AFRO Regional Committee featured WHO director general Dr Tedros Adhanom Ghebreyesus pledging support for Africa CDC and the African Medicines Agency, in an attempt to sooth purpoted tensions between the two agencies.

The Pan American Health Organization Directing Council, which met in early October, unveiled a roadmap for a new strategic plan, after member states adopted policies ranging from health system strengthening to climate and health adaptation and mitigation.

Kluge’s tenure began at the beginning of the COVID-19 pandemic, and along with the pandemic response, he has made a name for himself leading the Region through a broad range of other health emergencies. Those range from extreme weather events, to Europe’s mpox outbreak, the war in Ukraine and the Region’s response to crises in Africa and the Eastern Mediterranean regions. 

“By identifying and acting on priorities of importance to the almost one billion people across Europe and Central Asia, our Member States display welcome solidarity and multilateralism at a time of deepening distrust and division,” said Dr Kluge at the close of the Regional Committee session, where he was nominated for a second term. “Health can and does bring countries and communities together. We at WHO/Europe are grateful for the opportunity to work with our Member States and partners to help shape the future of health for the benefit of all.”

At the European Regional meeting, member states also discussed plans and strategies for: healthcare system resiliency and primary healthcare investment, health emergency preparedness – known as “Preparedness 2.0”, emergency medical teams capacity, and health innovations and emerging technologies. Member states also discussed five year plans and strategies around national health security, mental health, the climate crisis, and gender-based violence. 

Western Pacific focuses on improving health financing, digital health

The Western Pacific Region (WPRO) member states, home to more than 1.9 billion people across 37 countries and areas, including the Philippines, Malaysia, Australia, Korea, China, and Japan, met 21 to 25 October, adopting strategies that aim to increase national public health funding, and implement digital health solutions. 

Despite recent reforms in health financing, public health spending in the Western Pacific Region remains “inadequate” to meet growing needs, the WRPO said in a press release. The lack of healthcare service access and the financial burden of care costs presents a growing burden in the Region, where in 2019 more than 300 million people faced “catastrophic” health costs. 

To curb costs, the Regional Committee endorsed a regional action framework for health financing. The Framework aims to improve health financing through five action domains: 1) greater reliance on public funding for health; 2) more equitable and efficient health spending; 3) financing primary health care (PHC) now and into the future; 4) strengthening governance for health financing; and 5) promoting health for all in economic and social policy, according to a statement. 

The Committee also endorsed measures to accelerate digital healthcare technologies, which calls on countries to prioritize “governance, socio-technical infrastructure, financing and economics, digital health solutions, and data in strengthening health systems in the era of digital transformation.” 

Regional conflicts take center stage at Eastern Mediterranean regional committee

Dr Hanan Balkhy, EMRO director, at the Regional Committee meeting in Doha.

On 14 October, meanwhile, Eastern Mediterranean Region member states met in Doha, Qatar, for its 71st regional committee. The conflicts in Gaza, Sudan, Yemen, and Lebanon occupied much of the discussion. The devastation of health infrastructure and the outbreaks of vaccine-preventable diseases – “an unprecedented series of emergencies” – were the backdrop to the Committee’s “Health Beyond Borders” theme. 

“In several countries in the Eastern Mediterranean Region, conflicts, epidemics and political unrest have weakened health services, requiring responsibility, solidarity and equity to improve the lives of all people. We have learned from pandemics and epidemics the importance of solidarity, and that protecting health requires global efforts that transcend national borders,” observed Dr Hanan Al-Kuwari, Qatar Minister of Health in her opening remarks. 

WHO director general Dr Tedros Adhanom Ghebreyesus echoed the intensity of threats facing the region in his opening address, noting : “The eruption of conflict in Lebanon has put the health of millions more people at risk. The number of internally displaced people is growing rapidly, and so is the threat of disease outbreaks, compounded by overcrowding in shelters and the closure of hospitals.”

The Director General urged EMRO Member States to engage in Pandemic Agreement negotiations, “and if possible, to complete it by the end of this year” as well as to participate in the ‘WHO Investment Round’ that aims to raise some $7 billion in supplementary funds to fill a gaping hole in WHO’s $11 billion budget for the next four years. 

The EMRO four-year strategic plan focuses on three flagship initiatives: expanding equitable access to essential medicines, vaccines and medical products, investing in a more resilient health workforce and scaling up public health action on substance abuse. Member states formally adopted the plan at the end of the four day conference; approved a strategic frameworks for implementation of Immunization Agenda 2030, strengthening health laboratory services in the Region 2024–2029. The Committee also endorsed a new regional strategy to strengthen local vaccine production.

South Asia regional meeting under cloud of Regional Director’s controversy

Saima Wazed (in black), along with her mother Bangladesh Prime Minister Sheikh Hasina, during an official visit to the United States to meet US President Joe Biden and First Lady Jill Biden in 2023. A few months later, Wazed’s nomination as the next SEARO Regional Director was confirmed by the WHO Executive Board.

In New Delhi, meanwhile, South-East Asian (SEARO) Member States converged  in the first week of October to adopt resolutions on adolescent health and set measles and rubella elimination targets.  The meeting took place despite late summer unrest in neighbouring Bangladesh that saw Prime Minister Sheikh Hasina resign and flee the country. That followed the controversial election in February 2024 of Sheikh Hasina’s daughter, Dr Saima Wazed, as the new SEARO regional director – in a vote that critics said was laced with politics.

There were fears that the subsequent resignation of Sheikh Hasina could further complicate Wazed’s job as the new SEARO RD.  However, despite the political upheaval, the Regional Committee session took place on schedule.

The SEARO event also featured a number of regional health achievements by member states. Those included six countries’ attainment of SDG targets for reducing  under five mortality and still  birth rates; India’s elimination of trachoma; Timor-Leste’s elimination of lymphatic filariasis; Bhutan’s achievement of interim WHO targets for cervical cancer elimination; and Maldives and Sri Lanka’s progress on Hepatitis B control in children.

“The progress being made is the Region is heartening. I congratulate countries for their achievements which demonstrates their commitment to health and wellbeing of people. I look forward to together building on this momentum to further accelerate efforts for equitable access to health services for all in our Region in the coming years,” said Dr Wazed in a press release at the close of the meeting.

WHO ‘investment rounds’ now a feature of Regional Committee meetings

In a new twist on the decades’ old formula, WHO has also now been making use of the Regional Committee events to stage awareness-raising events about the agency’s new ‘Investment Round’ strategy – which aims to streamline and amplify member states’ voluntary contributions so as to raise roughly $7.4 million more to fund WHO’s 2025-28 budget of $11.1 billion.

In the case of the African, WPRO and SEARO regions, fund raising events even took place directly at the regional meetings. In the first-ever SEARO WHO Investment Round,countries pledged some $345 million, beyond their assessed annual contributions. That followed pledges from the African region for $45 million at their annual meeting in August. At the Western Pacific Regional meeting, in late October, meanwhile, countries pledged a total of $20 million.

As for other (richer) regions, such as the European Region, the Americas and the Eastern Mediterranean, those all-important pledges are being recruited and announced separately.  A gala European Region event was featured at the mid-October World Health Summit in Berlin, which garnered nearly a$1 billion for the organization – although major donors such as France, Spain and the United Kingdom did not announce commitments there.  As for the conflict-wracked EMRO region, which also includes wealthy Gulf countries, and the Americas, where a US election win by former President Donald Trump could lead to another US disengagement from WHO, as per the moves made during his last term, the Regional Committee meetings were used for briefings and awareness-raising. But it remains to be seen when and how concrete pledges will actually be finalized and announced.

WHO Secures $1 Billion at First European Investment Round

See the following links for Health Policy Watch coverage of outcomes from two other WHO regional committees – the Pan American Health Organization (PAHO) and the African Region (AFRO).

Image Credits: WHO/EURO, WHO/EMRO, X.

Abandoned cars and campers debris litter the entrance to theNova Music Festival in Israel, following the surprise attack by Hamas on festival goers in the early morning hours of 7 October 2023.

Israeli researchers were surprised to find that alcohol use, as compared to psychedelics, contributed more significantly to psychological challenges amongst survivors of the October 7, 2023, Nova music festival attack, following a study, conducted by researchers from Sheba Medical Centre and Ben-Gurion University of the Negev. The study was published in October in World Psychiatry.

On October 7, about 4,000 people were attending the Nova music festival in southern Israel when Hamas militants entered early in the morning and began attacking their encampment. The massacre claimed the lives of nearly 400 people at the festival, as well as another 800 people living in surrounding rural communities and military outposts. Some 250 people, including about 40 festival goers, were also abducted by Hamas and taken to Gaza.

Many attendees had consumed various recreational drugs and alcohol, including LSD, MDMA, MMC, cannabis, and combinations of these. They had to react quickly, fleeing and hiding to save their lives.

The research team wanted to examine how the use of these drugs and alcohol impacted the way attendees responded to the attack, explained Prof Mark Weiser, chairperson of the Division of Psychiatry at Sheba and a professor at Tel Aviv University. The team hypothesised that survivors who were on drugs at the time would have been more hyper-aware of the event and their surroundings, thereby experiencing more post/trauma from the attack overall. However, they were wrong.

‘It was the alcohol’

“It was the alcohol,” he told Health Policy Watch. “These people were the ones who had more severe post-traumatic symptoms.”

After the attack, a total of 232 people sought treatment at Sheba Medical Center, located near Tel Aviv, which was treating post-trauma victims. Of these, 123 survivors qualified for the study, after excluding those with severe physical injuries or histories of mental disorders, including prior PTSD, as well as two participants who had used hallucinogenic mushrooms and ketamine before the event. The latter two were excluded due to the small sample size for these substances.

The average age of participants was 28. Most (61%) were male, 69% were single, and 68% had at least a high school diploma or equivalent. Amongst participants, 71 reported using psychoactive drugs, 12 only alcohol, nine only LSD, seven only MDMA, six only cannabis, three only MMC, 15 a combination including alcohol, and 19 a combination excluding alcohol.

The researchers administered a series of questionnaires to assess how these substances impacted participants’ cognitive and stress responses during the attack. They found that all participants experienced high levels of anxiety and hyperarousal-related symptoms, regardless of drug use. Amongst those who had taken drugs, such responses were significantly elevated during the crisis, which lasted for hours.

Alcohol consumption and brain function

A installation in Tel Aviv’s Hostage Square to the victims of the Nova Music Festival attack; some 400 people died and 40 were taken hostage by Hamas on 7 October 2023.

Even so, those who consumed alcohol—either alone or with drugs—had a much greater likelihood of experiencing post-traumatic symptoms such as depression, anxiety, arousal and hyperactivity, as well as emotional numbness.

“Alcohol consumption exerts various effects on brain function and behaviour, ranging from anxiolytic and mild disinhibitory effects to sedation, motor incoordination, altered memory, and emotional processing,” the researchers wrote. “Therefore, pre-trauma alcohol consumption may have interfered with the cognitive, emotional, and psychological processes necessary to cope with the traumatic event.”

They researchers did not differentiate between the different types of drugs used as there was not a large enough sample size.

Weiser noted that this study only looked at participants up to two months after the event. To determine any potential long-term effects, or whether drugs and alcohol might impact cognitive responses differently over time, further research would be needed. Weiser said he hoped that he and his research team might follow up with these 123 participants to assess their status over a year after the attack.

He also emphasised the small sample size, which primarily includes “people who were treatment seekers,” meaning those who recognised their need for help.

“There were a lot of people at Nova who were frightened, saw horrible things, but they went home, and life went on,” Weiser said. “It is important to realise we are talking about treatment seekers and not a random sampling from the party.”

Weiser added that, statistically, 15% to 20% of people who experience trauma will develop longer-term post traumatic stress disorder (PTSD). He noted that PTSD has a very broad diagnostic range, including those who have recurring bad dreams or troubling memories as well as those whose trauma disrupts their daily lives and ability to function.

Suicide after trauma

Beyond this study, however, a comprehensive tracking of the health and mental health outcomes of the festival goers, has not been undertaken.

Just last week, one Nova festival survivor, 22-year-old Shirel Golan, took her own life after a year-long struggle with PTSD, according to her parents. Her death has sparked concerns about whether the country is providing enough support for survivors of the October 7 events.

Hundreds of survivors continue to face serious mental health challenges, including PTSD, survivor’s guilt, depression, and anxiety.

In April, festival survivor Guy Ben Shimon told a State Audit Commission that “there have been almost 50 suicides amongst the Nova survivors.” However, the Health Ministry quickly countered, stating it has no data confirming this claim, and Weiser agrees.

In response to October 7, the Israeli government established a public mental health support program offering free therapy. Survivors with PTSD qualify for up to 36 sessions, while others can receive up to 12. As of July, nearly 1,900 survivors had been referred for treatment. The government has committed about $5 million to this and related programs.

“Every suicide is a tragedy, but it is very premature and inappropriate to say [Golan] suicided because of her experience at Nova,” Weiser said.

“This does not mean it is not true, but suicide is a multifactorial event, and we don’t fully understand why one person may end their life while another does not.”

Both in Israel and the United States, studies have shown elevated suicide rates amongst those with PTSD, and especially those who served in the military.

As of 2021, 30,177 US active-duty soldiers and veterans who had served in Afghanistan, Iraq and other conflict zones over the past two decades, had died by suicide, as compared to 7,057 combat-related deaths over the same period, according to the United Service Organisations. In Israel, suicide also was the leading cause of death amongst soldiers in 2021, two years before the Gaza war broke out, with 11 soldiers taking their lives that year.

Image Credits: Kobi Gideon / GPO/Wikipedia, Chuttersnap/ Unsplash, Wikimedia.

Dr Yvan Butera, Minister of State in Rwanda’s health ministry, is vaccinated with Sabin’s experimental vaccine.

The spread of mpox in Uganda is “of great concern”, with some 830 recorded cases in 19 states, according to the Africa Centres for Disease Control and Prevention (Africa CDC).

Uganda’s first recorded case was in Nakasongola Prison in Central Uganda, but new cases have been reported close to the border with the Democratic Republic of Congo (DRC) while “new clusters” in fishing communities are a cause for concern, Dr Ngashi Ngongo, Africa CDC’s mpox lead, told a media briefing on Thursday.

In the past week, 61 new cases were confirmed and one death, he added.

Unlike the DRC where children make up half the mpox cases, only 12,5% of Uganda’s mpox cases are children. The majority, 63%, are adult men and clade 1b, which can be sexually transmitted, is the dominant strain. 

Meanwhile, Mauritius has recorded its first mpox case – and the UK recorded its first case of Clade 1b case in someone who recently travelled to a country with mpox, said Ngongo.

The continent’s weekly case tally increased by 2,766 cases – a similar increase to previous weeks. The vast majority of cases are in the DRC and Burundi.

Almost 900,000 mpox vaccines have been distributed to nine countries, with vaccination campaigns going well in the DRC and Rwanda. However, Nigeria postponed its planned vaccination campaign this week.

Four more Marburg cases

Meanwhile, Rwanda recorded four new Marburg cases in the past two weeks – a health worker (reported on last week) and three contacts of other cases, according to Dr Yvan Butera, Minister of State in the health ministry. Two people have also died in the past week.

Rwanda has confirmed 66 Marburg cases and 15 deaths reported, a case-fatality rate of around 23%. Close to 6,000 people have now been tested while close to 1,600 frontline workers have been vaccinated, said Butera.

The source of the outbreak has been traced to fruit bats in a mine near Kigali, which infected the index case who had visited the mine.

The Sabine Vaccine Institute has sent a further 1,000 of its investigational vaccines to Rwanda, the company reported on Thursday. These will be used for a randomized clinical trial arm within the ongoing open-label study.

Previously, Rwanda had rejected the World Health Organization (WHO) protocol, which would have involved a control group that got vaccinated three weeks after the trial group, according to the journal, Science.

Instead, Rwanda opted to vaccinate all trial participants  “as part of a Phase 2 rapid response open-label trial, sponsored by the Rwanda Biomedical Centre”, according to Sabin. 

“Under the updated protocol, sponsored by the Rwanda Biomedical Center, approximately 1,000 at-risk individuals, including mine workers, will receive Sabin’s single-dose investigational vaccine in a one-to-one randomization. Half will receive the vaccine immediately, and the other half 21 days later to align with the end of the disease incubation period,” according to Sabin.

Designed to prevent illness before exposure to the virus, Sabin’s Marburg vaccine has not yet been proven to have clinical benefit for recipients of the vaccine.

Image Credits: Sabin Vaccine Institute.

Cholera oral vaccine Sudan
A Sudanese child gets an oral cholera vaccine.

While the global stockpile of oral cholera vaccines (OCV) has been empty since mid-October, vaccine doses are being produced each week and shipped directly to countries in need, according to the World Health Organization (WHO).

“As soon as adequate quantities are produced, they are shipped to countries in need. This is why the stockpile can remain at zero for long periods. It does not mean that there is no production,” a WHO spokesperson clarified to Health Policy Watch after reporting on 18 October that the stockpile was empty.

This year, 30 countries have reported cholera outbreaks involving over 430,000 people which is driving demand for the vaccines.

Pharmaceutical company EuBiologics in the Republic of Korea is the only company currently producing cholera vaccines under the brand name, Euvichol.

However, the WHO prequalified a simplified oral cholera vaccine in April, which will “nearly double the available doses from around 45 million this year to about 90 million by 2026”, according to the spokesperson.

“But the current increase will not fully address the existing vaccine gap. The demand remains exceptionally high and is still growing, despite the increase in production.”

Huge demand

The global stockpile of the oral cholera vaccine was established in 2013 with two million doses. By 2023, this had expanded to 36 million doses. 

The stockpile is overseen by the International Coordinating Group on Vaccine Provision (ICG) consisting of the International Federation of the Red Cross and Red Crescent Societies, Médecins Sans Frontières, UNICEF, and WHO. 

Gavi, the Vaccine Alliance pays for the vaccine and its distribution to all eligible countries.

“The ICG has approved 14 million cholera doses for outbreak response over the last two months, a volume that represents twice the size of the current stockpile,” according to a Gavi spokesperson.

“However, while there may be short periods where all available doses are allocated to specific country requests, the stockpile is continually replenished on a rolling basis by the manufacturer.”

Investments made by Gavi and its partners to increase the volume and speed of supply have halved the timeline needed for replenishing the global vaccine stockpile this year. 

Gavi expects close to three million new doses to be made available this week, seven million in November, and six million in December, “all ready to be shipped to countries that may request them for ongoing outbreaks”.

 “In April we welcomed the arrival of a new OCV, Euvichol-S which enabled EuBiologics, its manufacturer, to produce more volumes of vaccine, faster, and at a lower cost – a key step to expanding supply amidst the ongoing acute global upsurge of cholera outbreaks,” said the Gavi spokesperson.

“The global availability of OCV has once again shown an annual increase from 38 million doses in 2023 to approximately 50 million in 2024, and is further expected to increase again in 2025, to 70 million doses,” said Gavi.

However, creating both sustainable and predictable demand for OCV, and supporting efforts towards long-term control by launching preventive programmes in endemic countries, is vital for controlling the disease, Gavi notes.

Image Credits: WHO.

Institute of Women’s Health’s Anita Mpambara Cox, former Trump officials Alma Golden and Valerie Huber and Burundi’s First Lady, Angeline Ndayishimiye, meet in Washington, DC.

Post 2020, ex-Trump officials have worked through NGOs to undermine abortion and LGBTQ rights in Africa, preparing the ground for his re-election

Despite Donald Trump’s electoral defeat as US president in 2020, his ex-officials and allies have never stopped campaigning for African countries to prevent abortion and LGBTQ rights  – in league with some of the most right-wing countries on the planet, including Russia and Hungary.

If Trump is re-elected on 5 November, he is likely to entrench opposition to abortion as a key pillar of US foreign aid. Project 2025, the controversial conservative blueprint for a Trump victory written primarily by his former officials, proposes that all US aid including humanitarian assistance, is conditional on the rejection of abortion.

“Proposed measures for USAID [US Agency for International Development] include a significant restructuring, and reduction of budget, the removal of diversity, equity, and inclusion programs, and dismantling of the apparatus that supports gender equality and LGBTQ+ rights,” notes researcher Malayah Harper in an analysis of Project 2025.

‘Sending people to their deaths’

“The return of Trump, at a time when nationalist African presidents are also prosecuting women and queer people, means sending these groups to their death,” observes Saoyo Tabitha Griffith, a Kenyan high court lawyer and women’s rights activist.

“This is not alarmist. It is purely informed by the observation of past patterns,” she tells Health Policy Watch.

One of Trump’s first presidential actions in 2017 was to prohibit foreign NGOs from receiving US government funding for health if they “provided, promoted, or discussed” abortion – known as the Expanded Global Gag Rule (GGR). 

Many family planning organisations lost their funding and women lost access to contraception in some of the continent’s poorest countries such as Madagascar and Ethiopia – ironically contributing to more unplanned pregnancies.

Banning abortion has never stopped it

But abortion bans have never stopped women and girls from trying to end unwanted pregnancies. It has simply driven them to unsafe providers whose methods often maim and even kill them.

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

While the percentage of women in Sub-Saharan seeking abortions has remained constant, the number of abortions has surged with population growth.

When Trump was elected, Griffith was deputy head of the Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN) which works on HIV and women’s issues.

“After the Expanded Gag Rule, we saw the deaths of sex workers. We saw the deaths of women who needed safe abortions. People died because service delivery programmes shut down,” she said.

Trump’s administration also cut funding to the United Nations Population Fund (UNFPA), effectively shrinking the budget of the global sexual and reproductive health agency by around 7%. This affected the provision of maternal and reproductive health services throughout the world – particularly in humanitarian settings.

Trump also froze the US contributions to the World Health Organization (WHO) in the middle of the COVID-19 pandemic.

In 2023, Republican congressional lobbying even put the brakes on the US President’s Emergency Plan for AIDS Relief (PEPFAR), claiming – incorrectly – that some grant recipients were promoting abortion. As a result of the right-wing lobby, PEPFAR projects now receive yearly budgets instead of five-year funding.

Ex-Trump officials prepare ground for his re-election

While legal abortion is out of the reach of most African women and girls, 19 African countries have eased access since 1994 – mostly in an attempt to reduce the maternal deaths caused by unsafe abortions.

Infographic: Abortion in Africa: 28 Years of Progress | Statista

But US groups have stoked opposition to easing abortion access in Africa, led most recently by Valerie Huber, the Trump-era Special Representative for Global Women’s Health, and Alma Golden, ex-Assistant Administrator for Global Health at USAID.

Huber was the architect of an anti-abortion pact, the Geneva Consensus Declaration (GCD), adopted in the dying weeks of Trump’s rule in October 2020 with the support of an array of global human-rights polecats such as Iraq, Uganda, Belarus and Sudan.

The GCD also promotes “the natural family” – primarly aimed at removing any recognition of the existence of  LGBTQ people.

When Biden withdrew the US from the GCD in 2020, Hungary took over the secretariat. However, Trump has confirmed that the US will rejoin the pact if he is elected “to reject the globalist claim of an international right to abortion”.

After Trump’s defeat, Huber and Golden launched an NGO called the Institute for Women’s Health (IWH) in 2021, to seek support for the GCD. The IWH is on Project 2025’s advisory board. Its Africa coordinator is Phillip Sayuni, a Ugandan anti-gay pastor, while its international programmes director, Anita Mpambara Cox, is a Ugandan American who sought election as a  Republican Senator in 2022.

Valerie Huber addressing the fourth anniversary of the anti-abortion pact, the Geneva Consensus Declaration, in Washington DC, in September in front of the flags of signatories, including Iraq, Belarus, Benin and Hungary.

In the past year, the IWH has persuaded Burundi and Chad, countries with poor human rights records, to sign the GCD. Burundi only allow abortion to save the life of a pregnant woman, not even allowing it in cases of rape and incest. Women who have abortions face prison sentences. The military dictatorship in Chad allows abortions to save a woman’s life and in cases of rape and incest.

Since forming IWH, Huber has courted several right wing African governments, including Sudan, South Sudan, Mali, Burkino Faso and Tanzania, but her closest links are with the Ugandan government.

Support from US conservative Christian groups

Supporting Huber’s anti-abortion, anti-LGBTQ crusade is a phalanx of conservative US NGOs active in Africa, particularly Family Watch International (FWI), headed by conservative Mormon Sharon Slater. FWI has been pushing the same agenda in Africa for over 20 years, and Slater and Huber both work closely with Ugandan First Lady Janet Museveni.

Several of these US groups also oppose contraception and sex education for school children known as “comprehensive sexuality education”.

The African spending of 17 conservative US Christian organisations known for opposing sexual and reproductive rights, including FWI, almost doubled after Trump’s 2020 defeat. FWI’s spending increased by 495%, albeit off a low base.

The 17 groups spent about $16.5 million in Africa between 2019 and 2022, with almost a third ($5.2 million) in 2022, the year after Biden took office, according to the Institute for Journalism and Social Change (IJSC). 

Institute for Journalism and Social Change (IJSC)

Importing US anti-LGBTQ laws

A group of US anti-rights groups have worked with conservative African politicians for decades to encourage laws that crack down on the very existence of LGBTQ people across the continent. 

In the past year, Uganda and Ghana have passed draconian anti-LGBTQ laws with the encouragement of these US groups, particularly FWI.

US conservative Christian group Family Watch International leader Sharon Slater (centre, black dress) meets Uganda’s first lady, Janet Museveni (centre, white skirt) in April 2023 to encourage the passage of the  country’s Anti-Homosexuality Bill.

FWI was one of the driving forces behind the recent Inter-Parliamentary Conference on Family Values and Sovereignty, which also received a $300,000 boost from the Russian government, according to a recent Wall Street Journal exposé. 

The conference also featured speakers who attacked routine vaccination campaigns and the World Health Organization (WHO), as previously exposed by Health Policy Watch.

However, its main agenda was to galvanise support from politicians across Africa for anti-LGBTQ, anti-abortion legislation.

The government of Kenyan President William Ruto, the country’s first evangelical leader, is considering “family values” laws to crack down on LGBTQ people and even make divorce more difficult. 

Copycat laws from US

Kenyan LGBTQ activist Āryā Jeipea Karijo says that parts of her country’s anti-LGBTQ Bill are “a direct copy” of US anti-transgender bills. 

Two concerns in the Bill – transgender people’s access to bathrooms and minors transitioning – “are not contextual to Kenya’s state of access to water as well as to meeting healthcare needs of transgender people”, Karijo says.

Kenya is struggling to provide adequate toilets in many schools and there is very little opportunity for adults to transition, let alone minors, she explains to Health Policy Watch.

“A side-by-side reading of US anti-transgender legislation and sections of the anti-LGBTQ laws that have been passed in Ghana, Uganda, and are proposed for Kenya, show that the authors are the same, and they are definitely not from the continent,” adds Karijo.

Meanwhile, Namibian LGBTQ activist Omar van Reenen notes that “anti-rights groups in the US share resources, strategies and rhetoric internationally”.

“The transnational exchange of anti-rights ideologies imported from American evangelical groups and NGOs like Family Watch International are alive and well,” said Van Reenen in a recent interview with the journal, Transcript.

Griffith sounds a grim warning if Trump wins the US election: “African women and LGBTQ people must anticipate that Trump’s return will re-ignite an ideological war with real and physical consequences on their bodies.

“Issues such as contraceptives, surrogacy, single parenting, safe abortion, HPV vaccines and sexual orientation are all going to be contested, not through science and data but by conspiracies and misinformation.”

Image Credits: IJSC.

In Pakistan, a healthcare worker listens to a child’s lungs for signs of pulmonary tuberculosis.

Shaka Brown was diagnosed with tuberculosis (TB) in November 2023.

“I was dropped off at the emergency room in Miami, Florida,” he recalled. “In September, I thought I’d caught the flu, but after weeks of night sweats, fainting spells, and losing my hearing in my left ear—and over 50 pounds—I knew something was wrong.”

Brown underwent ultrasounds, X-rays, and a battery of tests within hours of arriving. Then, the doctors delivered the news: he had TB.

“I told them no one gets TB,” he said. But Brown was quickly moved to a negative-pressure isolation room. “It turned out they were right. I had TB everywhere.”

Shaka Brown
Shaka Brown

The bacteria had spread from Brown’s lungs to nearly every organ in his body, including his bladder, brain, and spine. The infection had compromised his lower spine, causing sharp pain down his leg.

“The hospital had a molecular diagnostic machine, which helped them quickly figure out that I needed a specialised drug regimen. The standard treatment wouldn’t work for me,” he said.

“I started life-saving antibiotics the next day—over 15 pills every day. The TB growth was halted within a week. I remember slowly opening my eyes, surrounded by doctors who told me I was going to make it. It was only then I realised how close I’d come to not making it.”

Despite daily pills, four months later, Brown was back in the hospital, this time with seizures and unable to speak.

“The TB in my brain wasn’t going away as quickly as they hoped,” Brown said.

A week later, he underwent brain surgery to remove the infection. His doctors added anti-seizure medication to his TB regimen.

“They told me they’d stick with me every step of the way,” he added.

However, as Brown highlighted Tuesday during a presentation of new TB data by the World Health Organization (WHO), not everyone shares his good fortune.

“Twenty percent of people who get TB are never diagnosed and, therefore, never treated,” he said. “If we could just identify and treat those individuals, we could save lives. Every person we miss gives the bacteria a chance to evolve, weakening the effectiveness of current treatments. Yet, funding for research to develop effective drugs is decreasing.”

TB is top infectious disease killer in 2023

World Health Organization's 2024 Global Tuberculosis Report.
World Health Organization’s 2024 Global Tuberculosis Report.

Brown’s message was underscored by the WHO’s release of its 2024 Global Tuberculosis Report. The 68-page report offers comprehensive data on TB trends and the global response, covering 215 countries and regions, including all 193 WHO member states. It provides the latest insights into the TB epidemic, tracking global, regional, and national progress, along with the impact of key factors driving the disease.

In 2023, TB reclaimed its position as the world’s leading infectious disease killer, following three years when COVID-19 took the lead. It caused almost twice as many deaths as HIV/AIDS. Specifically, there were an estimated 1.25 million deaths in 2023, including 161,000 amongst people with HIV.

“The fact that TB still kills and sickens so many people is an outrage, when we have the tools to prevent it, detect it and treat it,” said Dr Tedros Adhanom Ghebreyesus, WHO director-general. “WHO urges all countries to make good on the concrete commitments they have made to expand the use of those tools, and to end TB.”

Globally, the number of deaths caused by TB fell in 2023, reinforcing the decline seen in 2022 after increases during the worst years of the COVID-19 pandemic. However, the number of people contracting TB rose slightly to approximately 8.2 million, the highest number recorded since WHO began global TB monitoring in 1995. This represents a notable increase from the 7.5 million reported in 2022.

Of those who developed TB, 55% were men, 33% were women, and 12% were children and young adolescents.

While TB occurs worldwide, 87% of cases in 2023 came from 30 high-burden countries. The majority of new TB cases were in Southeast Asia (45%) and Africa (24%), with smaller percentages in the Western Pacific (17%), Eastern Mediterranean (8.6%), the Americas (3.2%), and Europe (2.1%).

Eight countries accounted for two-thirds of the total: India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh, and the Democratic Republic of Congo.

Several major risk factors drive a significant portion of TB cases, including undernutrition, HIV infection, alcohol use disorders, smoking (especially amongst men), and diabetes.

Since 2000, TB prevention and treatment efforts have saved 79 million lives. The global gap between estimated TB cases (incidents) and reported new diagnoses (notifications) narrowed to about 2.7 million in 2023, down from around 4 million in 2020 and 2021 and below the pre-pandemic level of 3.2 million in 2019.

Drug-resistant TB remains a serious public health threat, said Dr. Tereza Kasaeva, WHO’s Global TB Program director. Presenting the data to health officials and the press on Tuesday alongside Brown, she noted that in 2023, 175,923 people were diagnosed and treated for multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB)—just 44% of the estimated 400,000 cases worldwide.

Trial Finds Four New Treatment Options for Multi-Drug Resistant Tuberculosis 

Kasaeva said progress toward global TB milestones and targets is lagging, including those set for 2027. Global funding for TB prevention and care dropped in 2023. Of the $22 billion target, only $5.7 billion was received—just 26% of the goal, with low- and middle-income countries bearing 98% of the TB burden.

“With only 26% funding, it’s impossible to provide 100% access for everyone in need,” Kasaeva said.

Domestic sources provided 80% of TB funding, while international funding for low- and middle-income countries has held steady at around $1.2 billion per year. Funding for TB research also remains critically low at around $1 billion per year—just a fifth of what’s needed.

“This is absolutely insufficient,” Kasaeva said.

“We are confronted with a multitude of formidable challenges: funding shortfalls and catastrophic financial burden on those affected, climate change, conflict, migration and displacement, pandemics, and drug-resistant tuberculosis, a significant driver of antimicrobial resistance,” Kasaeva added. “It is imperative that we unite across all sectors and stakeholders, to confront these pressing issues and ramp up our efforts.”

‘We can end TB’

Cheri Vincent, TB Division Chief at the US Agency for International Development (USAID)

The United States is the largest bilateral donor to global TB efforts, thanks to bipartisan support from Congress, explained Cheri Vincent, TB Division Chief at the US Agency for International Development (USAID), who also spoke on Monday.

Since 2000, USAID has invested $4.7 billion in the fight against TB.

“We have a global TB strategy for 2023 to 2030 that focusses on our 24 priority countries,” Vincent said.

The strategy aims to ensure that 90% of people with TB, including drug-resistant TB, are diagnosed and treated. It also seeks to provide preventive treatment for 30 million people eligible for it.

“While it’s heartening to see some positive trends in our battle against TB, we must confront a harsh reality: despite our efforts, we are merely treading water, failing to make significant strides toward our goal of ending TB,” said Dr Cassandra Kelly-Cirino, executive director of the International Union Against Tuberculosis and Lung Disease, in response to the report.

“To create a world free from TB, we must urgently address the areas where we continue to fall short.”

She added, “We’re diagnosing only 48% of the individuals needed to meet the 90% target. This is unacceptable. We must ramp up testing, ensure timely diagnosis, and support effective treatment to turn these numbers around and accelerate the reduction in the global TB incidence rate.”

Similarly, Peter Sands, executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, stated, “The big message from this year’s World TB Report is that if we act decisively, we can end TB.”

“We have momentum, tools, and leadership, but we need more funding—and we also need to dismantle human rights and gender-related barriers that prevent people from accessing the services they need,” he continued. “Winning will take political will and sustained commitment. In a world facing increasing challenges from conflict and climate change, we cannot hesitate.”

Image Credits: Stop TB Partnership, Shaka Brown's official website, World Health Organization.

The joint statement comes as the science on the effects of ultra processed foods continues to evolve.

Diets should be guided by four key principles, say the Food and Agriculture Organization (FAO) and World Health Organization (WHO) in a joint statement released this week. Their statement highlights the importance of adequate, balanced, moderate, and diverse food intake, and aims to clarify what exactly a healthy diet means. 

“With such prominence in the scientific literature and public media has come a range of definitions and perspectives about what constitute healthy diets, and how these can be achieved, while protecting the environment,” the FAO said in an introduction to the statement.

Unhealthy diets are a lead driver of non-communicable diseases like heart disease, obesity, and diabetes.

FAO and WHO released the statement alongside this year’s annual meeting of the Committee on World Food Security, where stakeholders gathered to strengthen policy responses to food crises, and the Convention on Biodiversity in Cali, Colombia.

Both events prompted the FAO and WHO to clarify the idea of a “healthy diet” while celebrating the “diversity of healthy dietary patterns.”  

Skirting questions about ultra-processed foods 

Unhealthy diets and foods
Ultra processed foods are linked to adverse health outcomes, yet it may take several more years for regulatory bodies to issue guidelines on UFP consumption.

Food intake should be adequate, balanced, moderate, and diverse, according to the statement. Diets should provide enough nutrients in a moderate and balanced way, with a wide-variety of nutrients across food groups. 

With daily media coverage of dietary advice, scientific studies on the ‘best’ diets, and the growing threat of climate change on food systems, the statement’s simple message consolidates several decades of scientific research

Yet the statement acknowledges that further research is needed before issuing recommendations, especially on ultra-processed foods (UFP), including sugar-sweetened beverages and desserts, dyed snacks, and processed meats. 

More than 50% of energy intake comes from UFP in high-income countries, and this trend increasingly mirrored in lower- and middle- income countries. 

“It’s probably going to take another several years to have a sufficient evidence base,” noted Dr JoAnn Manson, a physician and researcher at Harvard, in a recent STAT news article.

In the meantime, the WHO and FAO recommended “considering moderation” of UFP. Other regulatory bodies, including the US Department of Agriculture (USDA) and Health and Human Services (HHS), are set to issue their own dietary guidelines by the end of the year. The Dietary Guidelines for Americans, 2025-2030, edition, will also likely not include definitive advice about UFP. 

Image Credits: Scott Warman/ Unsplash, Leon Ephraim/ Unsplash.

Climate plans ‘miles short’ of averting catastrophe, UN climate chief warns ahead of COP29.

Global climate plans will cut emissions by just 2.6% by 2030, falling 40% short of what’s needed to keep a future within the Paris agreement’s 1.5C goal alive, according to a report released Monday by the United Nations Framework Convention on Climate Change (UNFCCC).

The combined emissions cut by the national climate plans, known as “nationally determined contributions” (NDCs), have increased by a mere 0.6% since last year, an insignificant change that will not affect global warming trajectories, the UN climate body said in its annual assessment ahead of next month’s COP29 summit in Baku.

“Current national climate plans fall miles short of what’s needed to stop global heating from crippling every economy and wrecking billions of lives and livelihoods across every country, said Simon Stiell, UNFCCC’s executive secretary. “Greenhouse gas pollution at these levels will guarantee a human and economic trainwreck for every country, without exception.”

As countries prepare to update their climate pledges ahead of next year’s COP30 in Brazil, time is running out to take the existential scale of the threat seriously. Since COP28, where countries adopted the UAE consensus reaffirming the 1.5ºC target established in 2015, only one nation has submitted updated climate plans under the treaty framework.

World Faces ‘Catastrophic’ 3.1C Warming after Year of Zero Climate Action

The UNFCCC’s dire assessment mirrors findings released last week by the UN Environment Programme (UNEP), which reported that no policies with “significant implications for global emissions” were implemented globally in 2023, putting the world on course for “catastrophic” warming of 3.1ºC by the end of the century.

UNEP maintains that the 1.5ºC target – which its director called “one of the greatest asks of the modern era” – remains “technically possible” if there is “immediate global mobilisation on a scale and pace only ever seen following a global conflict.”

With global emissions set to exceed 1.5ºC of warming by 2050 – and a one-in-three chance of breaking 2ºC – UNEP’s chief called for a “quantum leap” in climate policy.

Stiell echoed this urgency, demanding an immediate end to the “era of inadequacy” — and for “a new age of acceleration” to begin at next month’s COP29.

“The last generation of NDCs set the signal for unstoppable change,” Stiell said. “New NDCs next year must outline a clear path to make it happen – by scaling up renewable energy, strengthening adaptation and accelerating the transition to low-carbon economies everywhere.”

The latest warning shot 

Carbon dioxide is building up in Earth’s atmosphere at rates never before seen in human history, WMO reported Monday.

With COP29 in Baku, Azerbaijan, just weeks away, a raft of new climate research has reinforced the alarm bells set off by the UNFCCC’s findings.

Planet-warming greenhouse gases surged to record highs in 2023, reaching levels unprecedented in human history, new data released by the World Meteorological Organization (WMO) revealed on Monday.

The UN weather agency found carbon dioxide concentrations rose more than 10% in the past decade, while methane and nitrous oxide, short-lived but powerful greenhouse gases, also saw significant increases.

Carbon dioxide levels are now 51% higher than in pre-industrial times, when humans began burning fossil fuels at scale, while methane levels have risen 161% and nitrous oxide 25% over the same period, locking Earth’s atmosphere into a warming trajectory for at least the lifecycle of these gases.

 “Another year. Another record,” said WMO secretary-general Celeste Saulo. “These are more than just statistics. Every part per million and every fraction of a degree temperature increase has a real impact on our lives and our planet.”

“This should set alarm bells ringing among decision-makers,” Saulo said. 

Carbon dioxide is accumulating “faster than any time experienced during human existence” due to “stubbornly high fossil fuel” emissions, widespread forest fires, and a likely reduction in the ability of natural carbon sinks — such as oceans and forests — to absorb CO2, WMO said. 

The 2023 increase of 2.3 parts per million marked the 12th straight year of rises above 2ppm – a rate of increase that would have taken centuries to occur naturally before industrialization.

“The record levels of carbon dioxide in our atmosphere are the logical outcome of the record amounts of greenhouse gases that our economies continue to dump into our ambient air,” Joeri Rogelj, a climate scientist at Imperial College London and lead author of the report, told the Guardian. “This doesn’t need to be the end of the story.”

Earth’s systems near breaking point

The WMO report raises fresh alarms about nature’s carbon sinks — oceans, forests, plants and soil that absorb carbon dioxide — and it isn’t alone. Earlier this month, international researchers released preliminary findings indicating forests, plants and soil absorbed almost no net carbon in 2023, suggesting they could be nearing a tipping point.

These natural buffers, long taken for granted in climate models, may be failing. Earth’s natural carbon sinks absorb nearly 50% of our carbon emissions, and their collapse could be catastrophic and rapidly accelerate global warming beyond current worst-case scenario projections.

“We see a sudden drop of the land carbon sinks from extreme warming and Amazon mega-drought,” said Philippe Ciais, one of the report’s lead authors. “If this decline continues, we may see a rapid acceleration of CO2 and global warming which was unforeseen in future climate models’ projections.” 

Collapse of Atlantic current

Meanwhile, 40 of the world’s leading experts on ocean and climate science penned an urgent open letter presented at the Arctic Circle conference in Iceland last week warning that the risk of collapse of a vital Atlantic current system, known as the AMOC, has been “greatly underestimated.” 

The collapse of this system, one of the planet’s largest arteries transporting heat around the world’s oceans, would have “potentially catastrophic consequences” and trigger “devastating and irreversible climate impacts,” the letter warned. 

The worst impacts would be felt in Nordic countries and “potentially threaten the viability of agriculture in northwestern Europe,” while global impacts would include reduced CO2 absorption by oceans, major sea-level rise, and a shift in tropical rainforest belts, meaning rains would no longer fall on the forests they keep alive – triggering droughts above rainforests vital to absorbing CO2 – and flood the new regions they settle over.

“This has happened repeatedly in Earth’s history, most recently during the last ice age,” Stefan Rahmstorf, a signatory of the open letter and head of the Earth system analysis department at the Potsdam Institute for Climate Impact Research, said in an interview with the Guardian.

“These are among the most massive upheavals of climate conditions in Earth’s history,” Rahmstorf said. “I am now very concerned that we may push Amoc over this tipping point in the next decades. If you ask me my gut feeling, I would say the risk that we cross the tipping point this century is about 50/50.”

“We don’t know where the tipping point is.”

Image Credits: RecondOil.