Negotiations continue on health provisions in biodiversity plans as the UN summit in Cali reaches its midpoint.

Only 35 countries have submitted the national strategies required by the UN biodiversity treaty showing how they’ll meet its binding nature protection targets. While 33 of these plans recognise links between human health and biodiversity, they offer few specifics on implementation and policy, a Health Policy Watch analysis found.  Negotiators in Cali aim to bridge the gap this week by adopting a global health action plan under the treaty that provides a roadmap for meeting its health protection requirements.

Midway through the UN biodiversity summit COP16 in Cali, Colombia, delegates from nearly 200 countries remain deadlocked over rules to protect human health from Earth’s mounting ecological crisis.

UN Environment chief Inger Andersen urged delegates Thursday to break the impasse over the Global Action Plan on Biodiversity and Health, which would align conservation efforts with human health priorities as nations wrestle with implementing the landmark 2022 Montreal biodiversity treaty.

“Our health cannot be separated from the health of the planet and its many species,” she told delegates in Cali. “We must adopt this action plan and implement it with a holistic, systemic approach that unifies action across health, environment, finance, industry and agriculture.”

Over the weekend

Biodiversity deal seeks health rules – but keeps them voluntary

The world agreed to protect nature in Montreal two years ago. Now in Cali, countries must figure out how.

The proposed framework would strengthen the 2022 Kunming-Montreal biodiversity agreement – nature’s equivalent to the Paris Climate Accord – which committed 197 nations to protect 30% of Earth’s land and seas by 2030, but left crucial health provisions largely undefined.

While the Convention on Biodiversity itself is legally binding, the proposed health framework would serve as a voluntary roadmap for nations. It calls for health impact assessments in land-use planning, disease surveillance where habitat loss is rapid, and stricter wildlife trade rules — measures experts say are vital to prevent pathogens spreading from wild animals to human communities and food markets.

The framework also emphasises protecting genetic resources crucial for new medicine development and ensuring vulnerable populations have access to nature’s health benefits. The push comes amid controversy at the UN biodiversity summit over countries’ rights to demand “benefit sharing” when genetic resources, including digital sequences, are used in drug development — a fight at the frontiers of biodiversity science that nearly derailed the landmark 2022 Montreal agreement.

Beyond the fight over genetic resources, nations broadly agree on the framework’s other targets: combating vector-borne diseases emerging from shrinking habitats, reducing chemical exposure from industry, and protecting communities from the toxic toll of mass pesticide use.

If approved, the plan’s voluntary nature, combined with history, suggests an uphill battle: the world has not met a single UN biodiversity goal since talks began in Nairobi over 30 years ago.

Sweeping New Global Biodiversity Deal Sets Out Plan for Sharing Gene Sequences

The health focus at the UN biodiversity summit reflects a broader shift in environmental diplomacy, marked by the first-ever Health Day at UN climate talks (COP28) in Dubai last year.

While biodiversity has long been valued for medical discoveries — nearly half of all pharmaceuticals in use today are originally derived from nature — scientists increasingly see ecosystem protection as vital for preventing disease outbreaks, controlling disease vectors, and limiting chemical exposure.

Biodiversity loss and climate change have emerged as the leading drivers of infectious diseases worldwide, amplifying 58% of outbreaks. The mounting threat is forcing policymakers to reckon with an increasingly inescapable truth: human survival depends entirely on Earth’s life-sustaining systems — clean water, air, and food.

“Framing biodiversity as a resource – something separate, something that gives – has led to humanity converting nature, driving species to extinction, polluting ecosystems and pumping greenhouse gases into the atmosphere,” Andersen said. “But humanity is not separate from or above biodiversity. And in a closed system such as Earth, what goes around comes around.”

Deep divisions over superbug prevention and drug development mirror COP16 tensions

The Biodiversity-Health framework is one of the most contested documents being negotiated at COP16 in Cali, Colombia this week, according to Carbon Brief.

The 24-page Biodiversity-Health framework is as one of the summit’s most contested documents, with 54 bracketed sections exposing fundamental disagreements between nations.

The disputed clauses reflect wider fault lines in Cali. Nations remain divided over whether to classify improperly disposed antibiotic waste – a key driver of antimicrobial resistance – as “pollution” alongside microplastics and heavy metals. Proposals to “avoid the inappropriate use and disposal” of antibiotics are also unsettled, despite safe disposal practices being critical to preserving the efficacy drugs that save hundreds of millions of lives annually.

The sharing of benefits from genetic resources is another flashpoint. Developing nations demand strong commitments on technology transfer, while wealthy countries insist such transfers must remain “voluntary.” Nations with major pharmaceutical industries have pushed also back against draft language that would hold companies accountable for “the misappropriation of genetic resources and digital sequence information and associated traditional knowledge.

A crucial sticking point centres on whether to include “derivatives” and “subsequent applications and commercialisation” – essentially determining if companies must share benefits when they develop new products based on initial discoveries. Without such provisions, firms could potentially avoid sharing profits from derivative drugs or applications.

Finance – the dominant issue of COP16’s opening week – is another key battleground in the health framework. Nations have yet to approve clauses that would provide financial support to developing countries, which host most of the world’s biodiversity, for implementing plans to protect it.

Of the few plans submitted, most consider health

Of 35 submitted biodiversity plans, Western Europe leads with 13, followed by Asia-Pacific with 10, while Africa filed 5, Latin America 4, and Eastern Europe 3, according to the COP16 database.

National biodiversity plans submitted before this week’s summit in Colombia summit reveal wide variations in scope and specificity for how countries intend to tackle environmental protection and human health concerns, a Health Policy Watch analysis of the COP16 database found.

Only 35 nations – just 18% – submitted biodiversity strategies, known as NBSAPs in UN jargon, by Monday’s UN summit deadline. All but Mexico and Jordan included human health concerns in their plans.

The submitted plans reflect clear regional priorities. European Union members emphasize a comprehensive “one health” approach that links human, animal and environmental welfare, focusing heavily on pesticide and chemical pollution regulation – areas where the EU leads global policy.

Colombia’s strategy takes a different focus, centering on health impacts from extractive industries, particularly mercury contamination from mining. In contrast, China and South Korea’s plans barely mention health, making single references to urban green spaces’ benefits for respiratory and mental health.

These varied approaches come as research increasingly links ecosystem destruction to public health crises, from floods to disease outbreaks. Scientists have documented two virus spillovers to humans annually over the past century, culminating in the COVID-19 pandemic.

The World Health Organization projects climate change could cause 250,000 additional deaths yearly between 2030-2050. Antimicrobial resistance already claims 1.4 million lives annually, while environmental degradation could cause 39 million deaths from 2025-2050.

The proposed health framework, though voluntary, would set higher standards than current national plans.

“From the air we breathe to the water we drink, our health is tied to the health of the planet,” said UN Environment chief Andersen. “We need a plan to protect biodiversity for the health of all species on earth.”

Critical regions and powers missing from submissions

While most nations haven’t submitted biodiversity plans required by the Montreal deal, officials say the two-year timeline was ambitious given ecosystem complexity, especially in regions like the Amazon.

Of the 17 nations hosting 70% of Earth’s biodiversity, only five have filed plans: Australia, China, Indonesia, Malaysia and Mexico. The crucial Amazon region is represented solely by Suriname, with no submissions from Congo Basin nations.

The G7 economic powers showed limited participation, with only Canada, Italy, France and Japan meeting the deadline. Among G20 members, Brazil indicated it needs more time to develop its long-term conservation strategy, while India plans to announce its commitments during the summit.

“The start was never going to be fast. I think the important thing we’re looking at is the work is underway,” UN biodiversity chief Astrid Schomaker told Carbon Brief about the limited submissions.

“Whether the deadline itself is met on the dot is not what I think we’re really looking at,” Schomaker said, adding she is “confident” this work is taking place globally. “I think our assessment is globally positive.”

Biodiversity and health deal advances, but key framework still faces hurdles

Negotiations on biodiversity and health took a step forward on Sunday as the second working group’s chair presented a draft decision – a document separate from but related to the broader biodiversity and health action plan. While the draft includes a provision to adopt the action plan, this remains in brackets, indicating no consensus has yet been reached among member states.

The draft makes several key advances, eliminating previous disputes over antimicrobial disposal protocols and removing qualifiers that made technology sharing optional. It also strengthens provisions for Indigenous peoples’ participation in global biodiversity initiatives and decision-making forums.

However, several contentious issues from the main biodiversity framework remain unresolved. These include questions of pharmaceutical companies’ liability regarding genetic resource usage and digital sequence information, whether derivatives and commercial applications should be included in fair and equitable benefit-sharing arrangements, and the creation of international oversight mechanisms to ensure countries meet their biodiversity and health commitments.

Finance remains a critical hurdle in the health and broader COP16 negotiations. While eight nations boosted the Global Biodiversity Framework Fund this week with pledges totaling $163m, bringing available funding to $400m, this falls dramatically short of global needs.

The Kunming-Montreal agreement calls for $200bn annually for nature protection – 500 times the current fund’s total, which isn’t even structured as yearly financing. Though there is broad agreement on the principle of financial support from development banks and environmental funds, the mechanisms for distribution remain hotly contested.

As with previous UN environmental negotiations, talks may extend beyond the official Friday deadline as delegates work to bridge these remaining gaps.

This article was updated to reflect progress in the negotiations 

Image Credits: CIFOR-ICRAF.

Minya, Egypt
A view point in Minya Governorate. Nearly 11 million Egyptians live with diabetes, where insulin access is increasingly out of reach for those in rural areas.

MINYA GOVERNORATE, EGYPT – Nine-year-old Adam needs an insulin shot before meals, and seems unphased when his father checks his sugar levels with a finger pricking. He looks away when a small blood drop wells on the tip of his finger. Adam turns back to his plate of rice and stewed vegetables, continuing to ramble about the kids in his summer camp.

Both Adam and his father are diabetic in a rural village in Upper Egypt, where their struggle to access insulin mirrors a broader struggle across the country, and the continent. 

In a country where over 18% of adults live with diabetes, and with the number of adults living with diabetes expected to hit 20 million by 2045, diagnosis, monitoring, and medication are all difficult to come by. 

In response, Egypt is now taking significant steps to expand insulin access and diabetes prevention–in the context of rising prevalence. But financial and logistic barriers as well as  competing political priorities still leave rural families at the ‘last mile’ of service in a precarious situation. 

New diagnostics more widely available – but shortages, power cuts, and inflation threaten access

Minya, Egypt, diabetes access
Moussa, with his son Adam, shows a continuous glucose monitor in their home in Upper Egypt.

To address the growing health and financial burden of the disease, the Egyptian National Health Insurance system recently began to cover the initial cost of a glucometer for newly diagnosed people as well as 25 test strips per month. 

Yet while over-the-counter glucose monitoring ads flood US airwaves for non-diabetic consumers, many Egyptians, like people in other developing world countries, still struggle to obtain such basic devices for diabetes control. Diabetes care coverage remains below 50 percent for low- and middle-income countries, according to a Lancet estimate.

Many or most low-income and informal Egyptian laborers simply don’t have health insurance while their income are not enough to afford their monthly diabetes supplies, notes T1 International, a non-profit diabetes care advocacy group:  “It can cost someone more than 50% of their salary to get the basic diabetes supplies,” said Dr Mohamed Shabeen in a T1 article. 

insulin pens in egypt
Moussa’s stash of insulin pens and glucose monitors for the village.

Paying for test strips, monitors, and insulin are just one part of the country’s $3 billion diabetes-related annual health expenditure. The International Diabetes Federation estimates this number will rise to $4.5 billion by 2045, a concern given Egypt’s rising national debt and economic woes – with the Egyptian pound devalued by more than 50 percent and food inflation over 60 percent. 

There are also indirect costs for diabetics. For instance, Adam’s parents enrolled him in a pricier private school, over fears that in the overcrowded public schools, Adam could go into insulin shock unnoticed.

“I was worried he would go into a ketone coma (ketoacidosis),” said Moussa, Adam’s father, and English teacher who is one of the few-college educated people in his village of some 2,000 people. “I became diabetic in 2018, Adam in 2019. I noticed a lot of the same symptoms.

“When he was diagnosed, I did so much research. I had to learn about the condition because there is so little information for people with diabetes.” Moussa ended up buying a Freestyle Libre glucose monitoring system so Adam could attend school uninterrupted, but it soon became too expensive “and we’re facing a shortage.”

Villages, in Minya Governorate, like Moussa’s, struggle with affording insulin – and keeping it refrigerated during power outages.

There are several other people living with diabetes in his village, Moussa explained, and they have formed a network, providing each other with valuable social support. “We have a WhatsApp group. If someone has extra medication, they give it to me and then I distribute it to others that need it.” The summer, however, was especially challenging as 40 ℃ temperatures were accompanied by prolonged power cuts, threatening insulin refrigeration. 

Diabetes ascendant – 11 million and climbing

Diabetes coverage access
Diabetes treatment coverage remains below 50% across a variety of metrics in low- and middle-income countries.

In WHO Eastern Mediterranean Region, which includes most of the Middle East and North Africa, one in six adults now live with diabetes, making it the region with the highest prevalence at 16.2% and the second highest expected increase (86%) in the number of people with diabetes.The region also has the highest percentage (24.5%) of diabetes-related deaths in people of working age.

In Egypt, the country is now one of many facing a double burden of malnutrition (DBM)–where 21% of children under five are stunted yet over half of children and adolescents are overweight or obese. The country’s rapidly rising rates of noncommunicable diseases (NCDs) like diabetes, heart disease, and chronic respiratory diseases means that NCDs account for 82% of all deaths in Egypt and 67% of premature deaths. 

Public health experts point to the region’s lifestyle changes – a diet heavy in sugar and carbohydrates, lack of exercise, and other risk factors – as fueling the rise in NCDs. 

New domestic insulin production in limbo

Minya, Egypt diabetes
A view of the village in Minya Governorate, where the growing prevalence of diabetes threatens the village’s well being.

In terms of treatment, there is little local insulin manufacturing in Egypt as well as the rest of Africa, leaving people to depend on expensive, important supplies.  

Several big initiatives have recently been announced to change that. But their status remains unclear. In May, 2023, Eli Lilly announced a major new partnership with the Egypt-based pharmaceutical company EVA Pharma to provide the company with the active pharmaceutical ingredients (API) of insulin at a “significantly reduced price.” 

Just last month, EVA Pharma’s CEO Dr Riad Armanious declared in a press release that “locally manufactured insulin is currently a top priority, aiming for local supply and exporting it to more than 60 countries.” 

However, actual rollout of the plan still appears to be in limbo, with neither company responding when asked for comment by Health Policy Watch about the status of the new manufacturing plans.

That, despite an August statement by Egypt’s Minister of Health and Population  Khaled Abdel Ghaffar told press that the insulin shortage “would be over within three months” and that the country would produce a million more insulin vials a month, in coming months. 

He blamed a foreign currency shortage for the holdup in importation of critical raw ingredients needed to expand production, but “that the problem had been solved.”

Egypt is home to some 170 pharmaceutical factories – and state-owned companies already produce as much as 15 million vials yearly – but much of this also reportedly goes to export. This leaves Egyptians, who need some 27 million vials a year, in an even greater bind. 

Additionally, observers in the field say privately that the local products are not yet as of good quality as imported ones – something that the partnership between Eli Lilly and Eva should help address.

WHO – no further details on the rollout of manufacturing 

Egypt diabetes
Dr Loyce Pace, with WHO’s Dr Bente Mikkelsen, Africa CDC’s Dr Jean Kaseya and EVA Pharma CEO Riad Armanious at the EVA-Lilly partnership announcement last year.

Asked for comment, the World Health Organization also was unable to offer further updates on a timeline for Egypt’s rollout of its much-touted expanded insulin production. 

WHO is not a direct partner in the Eli Lilly-Eva partnership, but it has been “actively engaging with various stakeholders, including the private sector, to fulfill commitments made in the UN Political Declaration on NCDs,” said Dr Bente Mikkelsen Director, just prior to her retirement on 1 October as head of WHO’s Department of Noncommunicable Diseases, Rehabilitation and Disability (NCD).

“Several companies have responded positively to these ‘asks’, including commitments to local manufacturing,” she added, in a comment to Health Policy Watch. 

Meanwhile, in Minya Governorate, Moussa has been traveling more frequently to Cairo some four hours away by car “to get good healthcare” – after monitoring Adam’s symptoms, as well as his own, and their similarities. 

But he still hopes that he and others in his community can eventually get quality insulin and glucose monitors at a fairer price locally. 

“Right now, I’m getting them from Cairo, and we have to pay taxes and customs. It would be great for all these people in our community to be able to afford this as well.”

 

Image Credits: S. Samantaroy/HPW, The Lancet.

Dr Ngashi Ngongo (Africa CDC) and Dr Jean-Marie Yameogo (WHO), the continental co-leads on mpox.

Rwanda has recorded its 63rd Marburg case, while cases of children coinfected with both mpox and measles are rising in the Democratic Republic of Congo (DRC), according to officials at the Africa Centres for Disease Control and Prevention’s (CDC) weekly media briefing on Thursday.

After 10 days of no new cases, a health worker who has been caring for Marburg patients tested positive for the virus on Wednesday night, Rwandan Health Minister Dr Sabin Nsanzimana told the briefing.

But the health worker was vaccinated a few days ago and is “doing well” with disease presentation that was “not usual”, Nsanzimana added.

“The good thing is that the person has been in a treatment centre and has no contacts outside the centre,” he added. 

Meanwhile, the source of the Marburg outbreak has been traced to fruit bats in a cave where the index case had been mining, said Nsanzimana.

Once this had been confirmed, all human activity at the cave had been stopped and the government is following up on the people working there, to make sure they they don’t develop the disease, he added.

Genome sequencing of the virus confirmed that it was both very close to the zoonotic source – the virus in the bats – and to other Marburg cases imported into the country.

This underscored the importance of a One Health approach involving experts on human and  animal health and the environment, said Nsanzimana.

Mpox testing slowly improving

Some 2,729 new mpox cases were reported in the past week – over 90% of which in DRC and Burundi, although Liberia, Kenya and Uganda reported new cases, according to Dr Ngashi Ngongo, Africa CDC’s lead on mpox.

There has been an increase in mpox patients under the age of 15 being co-infected with measles in the DRC, particularly in Nord Kivu and Sud Kivu – but it is unclear whether one disease made children susceptible to the other. 

Little more than half the children in these areas have been vaccinated against measles and there is also a high malnutrition rate, which weakens the children’s immune systems, said Ngongo.

“We haven’t yet established if the fact that you get measles, then increase your chances of getting mpox and vice versa,” he added.

The DRC’s vaccination campaign underway in six provinces, was generally going well with over 39,000 people vaccinated. Nigeria plans to launch its vaccination campaign on 29 October.

“We have 5.6 million doses of mpox vaccines that have been confirmed, of which 2.5 million are MVA-BN and three million of the LC16 from Japan,” said Ngongo.

Close to 900,000 doses of MVA-BN are available this month October, with another 700,000 potentially available in November, which he described as being “enough, at least, for the moment, to cover the plans that we have received”.

However, getting vaccines for children remains a challenge although World Health Organization (WHO) has said that the MVA-BN can be used “off label” for children at risk.

After weeks of struggling to increase testing, there had been a 37% increase in tests in the past week – and a big jump in test positivity from 36.5% to 63%.

This can be attributed to training on sample management, PCR and Gene Xpert testing, more sequencing equipment, as well as the distribution of more Gene Xperts cartridges (to run the machines), and PCR tests being set to affected countries.

No new cases have been recorded in Cameroon, Gabon, Guinea, Rwanda and South Africa in the past four weeks.

However, surveillance has been a huge challenge, said Ngongo. Only four of the 18 affected countries had reached contact tracing targets of 10 per patient.

Meanwhile, the Robert Koch Institute in Germany reported the country’s first case of mpox Clade 1b. The patient recently traveled out of the country, but it not clear where he been. Outside of Africa, Sweden and Thailand have also each reported a case of mpox 1b, the more virulent version of the .

No policies with “significant implications for global emissions” were implemented worldwide in 2023.

Global efforts to reduce greenhouse gas emissions remain catastrophically off track, with current policies putting the world on course for a 3.1°C temperature rise by century’s end, the UN Environment Programme warned Thursday in its annual “Emissions Gap” report.

To keep the 1.5°C target alive, nations must slash emissions by 42% by 2030 and 57% by 2035 – yet emissions continue to climb, hitting record highs last year.

“Either leaders bridge the emissions gap or we plunge headlong into climate disaster with the poorest and most vulnerable suffering the most,” UN Secretary-General António Guterres told reporters at the report’s launch.

“The emissions gap is not an abstract notion. There is a direct link between increasing emissions and increasingly intense climate disasters worldwide,” Guterres said. “People are paying a terrible price.” 

Despite a year marked by devastating hurricanes, droughts and floods, no country implemented policies “with significant implications for global emissions in 2023,” UNEP found.

“Another year has passed without action, and that means we’re worse off,” said Ann Olhoff, the report’s lead scientific editor. “The findings are fairly similar to last year, apart from emissions still going up.”

Twenty-nine years after international climate talks began, the sum total of global climate pledges – known as Nationally Determined Contributions (NDCs) – would allow temperatures to rise by a “catastrophic” 2.6°C, even if fully implemented, according to the report. Most major economies, including many G20 nations, are failing to meet even these insufficient commitments – let alone achieve the 42% emissions cuts needed.

By mid-century, current trajectories point to warming well above 1.5°C, with up to a one-in-three chance of exceeding 2°C. The report warns that warming is expected to intensify beyond 2100, as CO2 emissions are not projected to reach net zero under existing scenarios.

Each year of delay makes the task harder: Global emissions must now fall 7.5% every year until 2035 to keep warming to 1.5 C. For a 2 C limit, yearly cuts of 4% are needed.

“If we procrastinate, that figure will obviously grow with every year of inaction,” said UNEP Executive Director Inger Andersen. “Nations must show a massive increase in ambition in these new NDCs, accompanied by rapid delivery, or the Paris Agreement goal of holding global warming to 1.5°C will be dead within a few years.”

With nations due to update their climate pledges ahead of COP30 in Brazil next year, UNEP says this represents a make-or-break moment. The new commitments must deliver what the agency calls a “quantum leap” to avoid planetary catastrophe.

“Limiting warming to 1.5°C is one of the greatest asks of the modern era,” Andersen said. “We may not make it. But the only certain path to failure is not trying.”

Going backwards

The Emissions Gap remains unchanged since UNEP issued the last edition of its annual report last year.

In a year that demanded cuts, emissions instead rose 1.3% to record levels in 2023, with coal accounting for 65% of the increase, according to the International Energy Agency.

While record deployments of renewable energy, nuclear power and electric vehicles helped curb emissions growth, they couldn’t keep pace with rising energy demand and the impact of severe droughts on hydropower generation.

Without this rapid expansion of clean technologies, emissions growth would have been three times higher, according to IEA data.

Only one pathway identified in the report halts warming beyond 2100: All 107 countries with net-zero pledges must deliver on their promises and quickly put their plans into action. This could cap warming at 1.9°C, but UNEP has “low” confidence countries will follow through. Countries accounting for 82% of global emissions have made net-zero promises, but progress has stalled.

“Current policies, conditional NDCs, unconditional NDCs – in any of these scenarios, whether emissions peak and fall a small amount or plateau, all of them represent a lost decade,” said Neil Grant, a lead author of the report.

“Winning slowly is the same as losing when it comes to climate change.”

G20 nations must ‘do the heavy lifting’

Just six countries accounted for 63% of global emissions in 2023, with the least developed nations contributing only 3%, highlighting particular concerns about inaction among major emitters, especially the G20.

“We identified very few newly adopted policies [by G20 nations] underpinned by quantitative assessments that deliver considerable emission reduction impact by 2030 or beyond. This is very worrying,” said Takeshi Kuramochi, lead author of the G20 section of the report. “It’s been a calm past 12 months, in a negative way.”

Seven G20 members – China, India, Indonesia, Mexico, Saudi Arabia, South Korea and Turkey – have not yet reached peak emissions, a pre-requisite to achieving net zero. For G20 nations that have peaked, including the US, EU, Russia and Canada, “their rate of decarbonization would need to accelerate – in some cases dramatically – after 2030 to achieve their net-zero goals unless they accelerate action now,” UNEP found.

“We must remember that 1.5°C is not an on-off switch that will plunge the world into an era of darkness and chaos,” Andersen said. “We are operating on a sliding scale of disruption. Every fraction of a degree avoided counts in terms of lives saved, economies protected, damages avoided, biodiversity conserved.” 

“The G20, particularly the members that dominate emissions, need to do the heavy lifting,” Andersen added. “Climate crunch time is here.”

‘Wartime’ mobilization is required to keep 1.5C alive

While there is “no chance” of limiting global warming to 1.5C under current policies, UNEP insists the target remains “technically possible” – but only through “immediate global mobilization on a scale and pace only ever seen following a global conflict.” 

A sweeping transformation of energy, transport, and land use could cut 31 gigatonnes of CO2 annually – equivalent to 52% of global emissions – through existing technologies costing less than $200 per ton of carbon, UNEP estimates.

Solar and wind energy alone could deliver 27% of required emissions cuts by 2030, rising to 38% by 2035, while forest protection and restoration could contribute another 20%. Together, these measures would deliver the steep emissions cuts scientists say are needed to keep 1.5C alive.

“Nations can deliver the cuts needed by investing heavily in solar power and wind energy, in forests, in reforming the buildings, transport and industry sectors,” Andersen said. “This is a gargantuan task that requires global mobilization on a scale and pace never seen before. But it does, for the moment, remain technically possible.”

The price tag for this transformation is steep but achievable, according to UNEP. Annual investment in mitigation measures must increase six-fold to 11.7$ trillion per year by 2035 – approximately 10% of the global economy.

“These investments don’t even take all the benefits into account and the avoided damages,” Olhoff said. “It would be very costly not to invest in a green transition.”

This is a developing story and will be updated.

Image Credits: Joanne Francis.

Final phase of oral polio vaccine campaign in northern Gaza has been postponed due to escalating violence.

The final phase of a planned polio campaign in northern Gaza has been postponed due to escalating violence in the area, the World Health Organization announced on Wednesday.

“Due to the escalating violence, intense bombardment, mass displacement orders, and lack of assured humanitarian pauses across most of northern Gaza, the Polio Technical Committee for Gaza… and partners have been compelled to postpone the third phase of the polio vaccination campaign, which was set to begin today,” WHO said in a press statement. “This final phase of the ongoing campaign aimed to vaccinate 119 279 children across northern Gaza.”

Since 14 October, the campaign to administer a second oral polio dose (nOPV2) to Gaza children under the age of 10 was rolled out successfully in central and southern Gazan regions, reaching some 442,885 children, WHO said.   It followed a first-dose oral polio vaccine campaign in September that succeeded in reaching 559,161 children, or an estimated 95% of those eligible, during a series of pre-arranged ‘humanitarian pauses’ that both Israel and Hamas observed.

The campaign followed on the identification of vaccine derived poliovirus in sewage over the summer, followed by a confirmed case of the paralytic disease in a ten-month old baby.

Second round faces more challenging circumstances

However, the second and final vaccination round, which began 14 October has taken place under much more challenging circumstances, particularly in northern Gaza where Israel has launched a major new military initiative in and around Jabalia refugee camp, ostensibly to root out Hamas forces that have resumed operations in the area; on 7 October, the anniversary of the first Hamas incursion into southern Israel, a barrage of missiles launched from nothern Gaza triggered sirens in Israel as far as Tel Aviv.  Palestinians and UN human rights agencies, however, have charged that the Israeli bombardment of Jabalia is part of a campaign to “ethnically cleanse” the northern part of the 365 square kilometer enclave, to make way for renewed Jewish resettlement of Gaza.

WHO has said that the escalation in violence made the final phase of the vaccine campaign impossible to execute right now.

“Given that the area currently approved for temporary humanitarian pauses was substantially reduced—now limited only to Gaza City, a significant decrease from the first round—many children in northern Gaza would have missed out on the polio vaccine dose,” WHO said in its statement.

Mass evacuation orders issued by Israel for people still living in Jabalia and other areas outside of Gaza City, would have also impeded the campaign’s reach, WHO said. Some 20,000 people have reportedly fled Jabalya in recent days.

“To interrupt poliovirus transmission, at least 90% of all children in every community and neighbourhood must be vaccinated – a prerequisite for an effective campaign to interrupt the outbreak and prevent its further spread,” WHO said. “Humanitarian pauses are essential for its success, allowing partners to deliver vaccination supplies to health facilities, families to safely access vaccination sites, and mobile teams of health workers to reach children in their communities,” it added warning that, “a delay in administering a second dose of nOPV2 within six weeks reduces the impact of two closely spaced rounds, concurrently boosting the immunity of all children and interrupting poliovirus transmission.”

Barriers to medical evacuations and hospital resupply

The increased violence has also impeded medical evacuations as well as the delivery of vital medical supplies to still partially-functioning hospitals, WHO said in a separate statement on Tuesday.

On a high-risk mission to northern Gaza on 20-21 October, WHO managed to evacuate 14 patiens and 10 caregivers, but was prevented from delivering “critical medical supplies, blood and fuel” to two Kamal Adwan and Al-Awda Hospitals, two partially functioning facilities still serving the area.

“Despite an initial agreement, the delivery of critical medical supplies, blood, and fuel – resources essential for keeping Kamal Adwan and Al-Awda hospitals operational – was denied just a few hours before the mission began on 20 October,” WHO said in a separate statement Tuesday.

The stepped-up fighting in Gaza takes place against the background of escalating violence between Israel and Lebanon, following Israel’s assassination of Hezbollah leader and Hamas ally, Hassan Nasrallah, on 27 September.  That has included heavy Israeli bombing of alleged Hezbollah targets as far north as Beirut, and hundreds of Hezbollah missiles fired into northern and central Israeli cities daily.  Against that landscape, WHO’s Director General Dr Tedros Adhanom Ghebreyesus, last week protested the fact that nearly a dozen hospitals in southern Lebanon have been forced to curtail activities or close, while flight cancellations to Beirut airport have also impeded the delivery of vital aid to the country.

Image Credits: WHO.

The venue of COP29 in Baku, Azerbaijan.

The United Nations (UN) climate change meeting, COP29, will feature a Health Day on 18 November as part of the negotiations in Baku, Azerbaijan.

The World Health Organization’s (WHO) Maria Neira said that the global body wants to ensure that health is “very prominent” in all the member states’ climate negotiations, which run from 11-22 November.

“We have two objectives. One is making sure that everybody understands that the climate crisis is a health crisis, and that climate change is negatively affecting our health, and we need to respond to that,” Neira told a media briefing on Wednesday.

“The second objective is to convince all the negotiators, participants, and member states that whatever they do to mitigate the process of climate change will have enormous potential health benefits,” said Neira, who directs the WHO’s Department of Public Health, Environment and Social Determinants of Health.

The Health Day will kick off with a high-level meeting on the Baku Initiative on Human Development for Climate Resilience, which aims to strengthen human development to address climate change, particularly in education, health, social protection, and green jobs and skills.

COP29 presidency official Elmar Mammador

“As part of the Baku initiative’s guiding principles, we emphasize the importance of science, knowledge generation and sharing as a part of the climate action,” COP presidency official Elmar Mammador told the briefing.

Other events focused on food, agriculture and water have health implications, while a high-level roundtable on 19 November on One Health “highlights the interconnectedness of human, animal and environmental health”, he added.

Mammador said that nine declarations had been finalised so far and some also offered opportunities for health interventions, including green energy, organic waste and pathways to resilient and healthy cities. 

A high-level meeting on resilient cities will be held on 20 November, which includes the integration of health in city planning.

“The President’s Climate and Health Continuity Coalition will have as one of its focus areas a platform where stakeholders can share reports and research findings on climate and health, and on biodiversity and health. Human health is inseparable from the health of our ecosystems, and biodiversity is essential to safeguarding human health,” said Mammador.

The WHO, in collaboration with the Wellcome Trust, is also hosting a Health Pavilion at the COP29 which aims to “ensure health and equity are placed at the centre of climate negotiations”, according to WHO. 

“It will offer a rich two-week programme of events showcasing evidence, initiatives and solutions to maximize the health benefits of tackling climate change across regions, sectors and communities,” said Neira.

Kenyan manufacturer Synergy’s new medical oxygen manufacturing unit is unveiled in Mombasa, supported by Unitaid.

A sod-turning ceremony in Mombasa, Kenya, on Tuesday marked the launch of the East African Programme on Oxygen Access (EAPOA), which aims to massively boost access to medical oxygen in the region.

Unitaid is investing $22 million in support for Kenyan manufacturers Hewatele and Synergy, and Tanzania Oxygen Limited to set up Africa’s first liquid oxygen regional manufacturing initiative. 

Medical oxygen is an essential lifesaving medicine used to treat a wide range of diseases and chronic heart and lung conditions including pneumonia, COVID-19, advanced HIV infection, severe tuberculosis and malaria. It is also vital for maternal and newborn survival as well as in surgeries, emergency, and critical care. 

Yet many parts of sub-Saharan Africa remain severely under-resourced with some countries accessing less than 10% of the oxygen they need.

The initiative is projected to save 154,000 lives in the two countries alone over the next decade, with the three manufacturers expanding the production capacity threefold by over 60 tons per day, enabling treatment of thousands of additional patients each month.

“The key role of medical oxygen at all levels of care cannot be over-emphasised. Kenya’s drive towards universal health coverage requires uninterrupted access to all health products and technologies including medical oxygen,” said Harry Kimtai, Principal Secretary of the Ministry of Health of Kenya.

“I congratulate Unitaid and all their partners for making funding available and providing technical support to make this possible. We look forward to working together to continue advancing initiatives that boost availability of other health products and technologies apart from medical oxygen”

 

“This is Africa’s first regional manufacturing approach to increasing access to medical oxygen,” according to Unitaid, which is working with governments in both countries and other partners.

“The program aims to expand medical oxygen production by 300% in East Africa and reduce oxygen prices by up to 27%, making it more affordable for health care systems across the region, and enabling treatment of thousands of additional patients each month,” added Unitaid in a media release.

The Clinton Health Access Initiative (CHAI) will lead on market strategy, while PATH will focus on community and civil society engagement. 

Blended financing

“Using an innovative blended financing approach that combines grants awarded to Unitaid by Canada and Japan, concessional loans, and support from MedAccess through volume guarantees, this program will strengthen the capacity of Kenyan and Tanzanian oxygen suppliers, fostering competition in the market and ensuring a sustainable, affordable oxygen supply across East and Southern Africa,” according to Unitaid.

 The EAPOA aims to develop a regional network of liquid oxygen production facilities, known as air separation units, to ensure medical oxygen reaches underserved communities. 

Air separation units produce bulk liquid oxygen, which is the gold standard for medical applications, with compact storage, economic efficiencies, and high purity level. However, building these units requires significant capital investment.

Aside from the Mombasa facility, other facilities are planned in the Kenyan capital of Nairobi, Kenya, and Tanzania’s Dar es Salaam. 

These will serve as the key hubs for the production and distribution of liquid medical oxygen to their home countries and their neighbours, including Malawi, Mozambique, Uganda and Zambia. 

Medical oxygen is essential for treatment many illnesses.

“The Mombasa facility is just the beginning of a larger effort to transform oxygen access across Africa,” said Unitaid executive director Dr Philippe Duneton. 

“Medical oxygen is critical for saving lives, yet too many health facilities in this region struggle with access. By working together with Kenyan and Tanzanian manufacturers and other partners, we are ensuring that oxygen is no longer a luxury but a basic right for all patients, especially in times of critical need.” 

The program is part of a broader Unitaid strategy to increase regional and local production of essential health products in Africa, in line with continental initiatives to enhance health security, such as Africa CDC’s Partnership for the Harmonization of African Health Products Manufacturing. 

“The Project will focus on three main aspects ensuring its sustainability,” said CHAI country director of East and Southern Africa, Gerald Macharia.

“Well-placed infrastructure selected in partnership with Ministries of Health, longer-term budgeting for liquid oxygen supply, and the grant/ loan /volume guarantees available to companies, which aim to facilitate lower pricing, patient access, and regular payment for services in the long-term.” 

Meeting in Nepal for the International Lead Poisoning Prevention Week 2024
A lead poisoning prevention workshop in Kathmandu, Nepal organized by the Ministry of Health and Population (MoHP) and WHO Country Office for Nepal.

The US Environmental Protection Agency (EPA) recently announced a new ruling that requires drinking water systems to replace lead pipes within 10 years. 

The rule also strengthens requirements to locate lead pipes, improve testing for lead in water, and ensure that exposure is minimized while lead pipe replacement efforts are underway.

“Families like yours, exposed to lead in the water–they deserve better… We’re finally addressing an issue that should have been addressed a long time ago: the danger lead pipes pose to our drinking water,” said President Biden earlier this month. 

The EPA estimates that up to nine million US homes are served through legacy lead pipes across the country, many of which are located in lower-income communities and communities of color, “creating disproportionate lead exposure burden for these families,” the agency said in a press release.   

To remove the millions of lead pipes still in use, the EPA has tapped $2.6 billion from the Bipartisan Infrastructure Law. The agency estimates that the public health and economic benefits of the final rule are estimated to be up to “13 times greater than the costs,” including protecting 900,000 infants from low birthweight, preventing 2,600 cases of ADHD, and reducing 1,500 cases of premature death from heart disease each year following the ruling. 

Sources of lead in drinking water
The EPA’s new ruling could over two thousand cases of ADHD and protect nearly a million infants from being born with low birthweight each year.

The Biden Administration’s announcement came just two weeks before International Lead Poisoning Prevention Week, which highlighted the persistent threat of lead for the world’s children population. 

“Lead continues to be one of the greatest public health concerns,” said Dr Maria Neira, World Health Organization (WHO) environment director. “Urgent action is required from member states to prevent exposure to lead.”

The United Nations Children’s Fund (UNICEF) estimates that one in three children have blood lead levels at or above 5µg/dl – levels that can cause lifelong neurological, behavioral, and health problems like anemia, hypertension, and toxicity to reproductive organs. “The science is clear,” noted an EPA statement, “lead is a potent neurotoxin and there is no safe level of exposure.”

Both the EPA and US Centers for Disease Control and Prevention (CDC) recommend having children tested for lead as the best way to determine exposure, especially if living in a house built before 1978.  

High risk of elevated lead in South Asia 

Lead exposure hot spots
South Asia, Africa, and parts of South America are lead exposure hotspots.

UNICEF’s landmark 2020 lead poisoning report exposed the scale at which children are exposed to high levels of lead. Of the 815 million children estimated to have elevated blood lead levels, nearly half live in India, Pakistan, Nepal, and other South Asian countries. 

The reasons for higher exposure, the UNICEF report notes, comes from a high prevalence of unsafe lead-acid battery recycling, and contaminated spices, ceramics, and toys. Children can also be exposed to lead in soil, dust, air, and water.  

Fewer regulations and enforcement leaves industries lacking environmentally safe practices, and the absence of blood lead screening make it difficult to protect children from lead hazards. The report also cites poor nutrition as a risk factor for higher lead absorption in lower-and middle-income countries. 

Brochures for healthy homes and lead prevention
Educational materials in Rochester, New York, for people at higher risk for lead poisoning.

“With few early symptoms, lead silently wreaks havoc on children’s health and development, with possibly fatal consequences,” said Henrietta Fore, UNICEF’s Executive Director at the time, at the report launch.

“Knowing how widespread lead pollution is — and understanding the destruction it causes to individual lives and communities — must inspire urgent action to protect children once and for all.” 

“Since the 1970s, efforts to reduce lead in paint, gasoline, water, yards and even playgrounds have resulted in considerable success in reducing blood lead levels among children in the United States,” wrote the report authors.

“The issue of lead poisoning is not new, but our understanding of the scope and scale of its impacts and feasible solutions has never been better. Proven solutions exist for low- and middle-income countries, those most burdened by this challenge. Those solutions can be implemented today.”

Image Credits: S. Samantaroy/HPW, WHO, EPA, UNICEF.

Rwandan Health Minister Dr Sabin Nsanzimana (left) and WHO Director General Dr Tedros Adhanom Ghebreyesus address a media briefing in Kigali on Sunday.

After a full week of no new Marburg cases, Rwanda appears to have contained one of the biggest recorded of the deadly virus outbreaks – and with a low case fatality rate of 24%.

World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyesus, who visited the country over the weekend, praised the level of Rwanda’s critical care for patients as well as how the country deployed high-level leadership  to address the viral haemorrhagic fever, which often kills over 80% of those infected.

“Two of the patients we met had experienced all of the symptoms of Marburg, including multiple organ failure, but they were put on life support, they were successfully intubated and extubated, and are now recovering,” Tedros told a media briefing in Rwanda on Sunday.

“We believe this is the first time patients with Marburg virus have been extubated in Africa. These patients would have died in previous outbreaks.”

Intubation involves inserting a tube through a patient’s nose or mouth into their windpipe (trachea) to help them breathe. This tube can be connected to a ventilator. Extubation is when the tube is removed.

Tedros added that Rwanda had worked for many years to “strengthen its health system, to develop capacities for critical care and life support that can be deployed both in regular hospital care and in emergencies”.

However, he warned that Marburg is “one of the world’s most dangerous viruses, and continued vigilance is essential”.

The outbreak will only be declared over once no new cases have been recorded for 21 days, potentially on 5 November.

Sabin’s vaccine candidate used

Although there are no approved vaccines or therapeutics for Marburg, Rwanda fast-tracked the trials of a vaccine candidate from the Sabin Vaccine Institute, and an antiviral drug, remdesivir.

On 5 October, Sabin delivered 700 doses of its single-dose candidate vaccine, followed by a further 1,000 on 12 October.

These have been used to vaccinate health workers “as part of a Phase 2 rapid response open-label trial, sponsored by the Rwanda Biomedical Centre”, according to Sabin. Patients’ close contacts have also been vaccinated.

Rwanda developed its own trial protocol after rejecting the WHO’s protocol which would have involved a control group that got vaccinated three weeks after the trial group, according to the journal, Science. Rwanda opted to vaccinate all trial participants at once.

However, the remdesivir trial does involve a control group.

“The swift initiation of the open-label trial was set in motion on 26 September, when the Rwandan President’s office contacted Sabin CEO Amy Finan to request assistance with the outbreak response,” Sabin said in a statement.

Rwanda officially declared the outbreak the next day.

“In an outbreak, every moment counts, and our seamless collaboration with the Rwandan government was key to accelerating the process,” said Finan.

Sabin’s manufacturing partner, Italy-based ReiThera, produced the drug substance and filled and finished doses for shipment to Rwanda.

“On our side, we moved quickly by leveraging our experience with other outbreaks and having vaccine doses and supporting documents ready, thanks to a strong partnership with ReiThera,” Finan added.

Sabin’s team only consists of 15 staff members, but Finan said that “their dedication, along with that of our Rwandan colleagues, BARDA [the US Center for the Biomedical Advanced Research and Development Authority] and other partners, enabled us to mobilise so rapidly. 

“This remarkable effort highlights the power of partnerships and preparedness in addressing urgent public health needs,” said Finan, who also visited Rwanda over the weekend.

Meanwhile, Tedros congratulated Rwanda for the speed with which it initiated trials of both vaccines and therapeutics, adding that the WHO hopes that these trials “will help to generate the data to support approval of these products for future outbreaks”.

Belen Calvo Uyarra, the European Union’s Ambassador to Rwanda, also praised the country’s rapid response to containing the virus.

“Respect to the government of Rwanda and the Rwanda Ministry of Health for proactive leadership, rapid and robust continued response, and professionalism of health workers,” Uyarra posted on X.

She and Tedros also visited the site of the BioNTech vaccine manufacturing facility, announced two years ago to facilitate local production of vaccines. 

“I was very pleased to see the significant progress in construction,” said Tedros.

“One of the key lessons of the COVID-19 pandemic was the need to expand local production of vaccines to avoid the inequitable access to vaccines that we saw, and we’re pleased to see the way Rwanda and BioNTech are investing in local production.

“You know how Africa was treated when the vaccines arrived, with vaccine inequity and vaccine nationalism, and we hope these strategic investments will fix the inequity problems we faced during COVID.”

 

European cities
Experts at the yearly Lancet International Health lecture argued that green urban planning can improve health.

Cities that fail to take meaningful climate action face a future of severe degradation with infrastructure collapse and environmental deterioration, warned climate and health experts at the yearly Academy of Medical Sciences & The Lancet International Health Lecture in London. 

“Madrid’s climate in 2050 will resemble Marrakech’s climate today. I don’t think we want that,” said Professor Mark Nieuwenhuijsen, the keynote speaker. To stave off this scenario, cities must adapt with health priorities at the forefront. “For our cities, we’re looking towards solutions that reduce CO2 emissions and also improve environment, equality and, of course, liveability and health.”

By 2050, two-thirds of the global population is expected to live in a city. Yet climate change is increasingly threatening human health in urban areas, where swaths of asphalt and concrete exacerbate rising temperatures. Climate change accounts for 37% of heat-related deaths, leaving cities especially vulnerable to heat waves and extreme heat. 

Dr Mark Nieuwenhuijsen argues that urban planners must consider health is designing the future of cities.

Preventing climate-related mortality in cities requires urban planning with an intentional health focus, commented Nieuwenhuijsen. He argued that smart urban planning reduces greenhouse gas emissions and promotes health, but only if we can break away from an “addiction” to fossil fuels.

“We know that these fossil fuels are responsible for more than 5 million deaths each year because of air pollution.” Despite the growing knowledge of the health burden of fossil fuels, cities continue to sprawl “with Europe leading the way.” Fossil fuel use has led to “car-centric asphalt-dominated urban planning and extensive urban sprawl, which have detrimental effects on health,” said Nieuwenhuijsen.

Sprawling urban areas increases car dependency, even though public transport systems and active transportation – like walking and cycling – are more cost effective. 

Compact vs green cities – policies that include the best of both models

European cities categorization
Four different European city configurations vary in their health and environmental effects–with compact cities being the lowest emittors yet having the highest mortality rates compared to less dense cities.

In Europe, where many cities are growing faster than their populations, high population density has potential advantages like shortened commute times, decreased care dependency, higher energy efficiency, and decreased building material consumption.

The more compact a city, the more efficient. Yet compact cities have potential drawbacks, including higher mortality rates, traffic density, air and noise pollution, and excess heat. 

Nieuwenhuijsen presented European cities as falling into one of four groups: compact high-density cities, open low-rise medium-density cities, open lowrise low-density cities, and green low-density cities. Analyzing cities across these categories show a split: cities either fall into higher mortality but lower greenhouse emissions, or lower mortality but higher emissions.

A city like Barcelona – compact and high-density -–can expect to have a 10-15% higher mortality rate, poorer air quality, and stronger heat island effect, but lower emission, explained Nieuwenhuijsen. Overall, the researchers estimated that poor urban planning results in 20% of premature mortality. “Barcelona is a wonderful city, but it has too much air pollution, too much noise, not enough green space.”

“In contrast, greener and less densely populated cities have lower mortality rates, lower air pollution levels, and a lower urban heat island effect, but higher carbon footprints per person.”

This dichotomy – where current urban configurations are either high emitters with better health quality, or lower emitters with worse health – means that cities must implement policies that better health and reduce emissions. Nieuwenhuijsen believes that both are possible. 

Policies that lower air pollution levels and reliance on cars, and increase green space, cycling lanes, and physical activity would “substantially reduce the mortality rate,” he argued. 

Super blocks, green space, and 15-minute cities

Barcelona superblocks
Barcelona is one a several major cities implementing innovative urban planning to improve environmental and human health.

Several cities have begun implementing innovative urban models that bridge the goals of lower emissions and healthier environments, especially in how they use public land.

“A lot of our public space in our cities is, at the moment, actually used by cars. I mean, in Spain, 69% of public space is used by cars because our roads are also public space. Parking is public space. I mean, this is the kind of space that we could use in a much better way,” commented Nieuwenhuijsen.

In Paris, a vision to become a “15-minute city” – where all major destinations can be reached within 15 minutes of the home – has increased investments in bike lanes and car-free zones.

Barcelona’s “superblocks,” London’s low traffic neighborhoods, and the Vauban Freiburg car-free neighborhood are all promising solutions to reduce premature deaths and increase green spaces.

 Nieuwenhuijsen and other experts convened at the event pointed to these examples and others as evidence that urban design changes are possible. 

Several Chinese cities have also embraced the intersection of urban planning and novel technologies to prevent flooding through their Sponge city designs, commented Dr Maria Neira, the World Health Organization’s director of Public Health, Environment and Social Determinants of Health. 

“More and more we need to be prepared to work with urban planners, the architects working at the city level. And I have the impression that sometimes they are better prepared, more advanced, more engaged and more passionate, than our public health officers working at the city level,” said Neira.

“So we need to sort it out and create these very strong arguments for our public health officers as well, to push at the city level, at the Urban level, for engagement with the Urban healthy urban planning.” 

Image Credits: Michele Castrezzati, Fons Heijnsbroek, The Lancet, The Lancet.