Drought in Burkina Faso

Drought data shows “an unprecedented emergency on a planetary scale”, according to a report released as the world leaders meet in Dubai at the annual climate summit, COP28, to discuss response to climate change.

The report warns that the “massive” impacts of human-induced droughts are only beginning to unfold, with data showing that droughts are worsening across the world.  Asia, particularly China, and the Horn of Africa, are the worst-hit. Up to 85% people affected by droughts live in low- and middle-income countries (LMIC).

The report was launched by the UN Convention to Combat Desertification (UNCCD) in collaboration with International Drought Resilience Alliance (IDRA).

Africa’s drought-related economic losses in the past 50 years are estimated to amount to $70 billion. Meanwhile, Argentina’s soybean harvest this year is expected to drop by 44% compared to the average of the past five years thanks to drought. It would make this the lowest yield since 1989 for the country and is set to cause a 3% drop in the country’s GDP this year.

“Unlike other disasters that attract media attention, droughts happen silently, often going unnoticed and failing to provoke an immediate public and political response. This silent devastation perpetuates a cycle of neglect, leaving affected populations to bear the burden in isolation,” said Ibrahim Thiaw, Executive Secretary of UNCCD.

UNCCD is one of three conventions that originated at the 1992 Earth Summit in Rio de Janeiro. The other two address climate change, the UN Framework Convention on Climate Change (UNFCCC) and biodiversity, the UN Convention on Biodiversity (UN CBD). 

IDRA is a global coalition of 34 countries that aims to create political momentum, mobilize finance and technical resources for a drought-resilience.

Worsening droughts are causing the loss of grazing land and forests, according to the latest UN data.

China, Horn of Africa – most vulnerable regions

In China around 15-20% of the population is likely to face frequent moderate to severe droughts by the turn of this century and the intensity of these is expected to rise by 80%. In the Horn of Africa, drought had already made 23 million people food insecure by the end of December 2022.

In North America, countries like the US are also facing worse drought periods, while the 2022 drought in Europe was the worst in 500 years. 

A key impact of droughts has been the reduction of food production, which has consequently affected the health and nutrition of dependent communities. Between 2016 and 2018, 70% of cereal crops were damaged by drought in the Mediterranean region. 

“With the frequency and severity of drought events increasing, as reservoir levels dwindle and crop yields decline, as we continue to lose biological diversity and famines spread, transformational change is needed,” Thiaw said, calling this report a wake-up call. The report draws on existing research and evidence from a range of agencies around the world.

Even if the average global temperature rise is restricted to 1.5 degrees Celsius compared to the pre-industrial period, 120 million people will experience extreme drought. If the temperature rise continues on the current trajectory, this number would swell to 170 million, according to the report.

Global carbon emissions are continuing to rise in 2023, according to the latest data from the World Meteorological Organization WMO). At this point, research places the future global temperature rise at anywhere between two to three degrees Celsius. 

“Several countries are already experiencing climate-change-induced famine,” the report said. “Forced migration surges globally; violent water conflicts are on the rise; the ecological base that enables all life on earth is eroding more quickly than at any time in known human history.”

Nearly a third of grazing land in South Africa has been lost to drought and the expected forest loss in the Mediterranean region in the high emission scenario is twice to thrice the current rate of forest loss, the report said.  

Apart from causing a rise in water stress for local communities, animals and forests, droughts are also affecting the shipping industry.  

During 2022, ships’ arrivals and departures were delayed in Europe due to low water levels on the Rhine River and this led to a 75% reduction in cargo capacity of some vessels. Low water levels in the Mississippi River in the US caused an economic loss of $20 billion as it led to supply chain disruptions.

What response could look like

The report also clearly spells out what the response to worsening droughts could look like, underlining that land restoration, sustainable land management and nature-positive agricultural practices are critical to building drought resilience.

“Urban intensification, active family planning, and curbing rapid population growth are prerequisites for societal development that respects planetary boundaries,” the report said.

The reduction or further conversion of global forests and natural land for agriculture could be halted if consumers cut their consumption of animal products such as pork, chicken, beef and milk.

Early warning systems are an important response to building drought resilience, according to the report. Efficient water management is another key component of global drought resilience. This includes investing in sustainable water supply systems, conservation measures and the promotion of water-efficient technologies.

The adoption of early warning systems is another key response to prepare for drought. Investing in meteorological monitoring, data collection and risk assessment tools can help respond quickly to drought emergencies and minimize impacts. Building global drought resilience requires international cooperation, knowledge sharing and environmental and social justice.

Global cooperation will be the key, the report added. “We need to reach binding global agreements for proactive measures that are to be taken by nations to curtail the spells of drought,” the report said. 

Image Credits: Yoda Adaman/ Unsplash.

On the eve of the first-ever COP Health Day, 124 countries endorsed a milestone declaration on climate and health. The political declaration marks the first time that the health impacts of climate change have taken centre stage in 28 years of UN climate talks.

At the 2016 UN Climate Conference in Marrakesh, a small group of public health professionals from around the world laid out the shocking connections between the more than half a million childhood pneumonia deaths annually and children’s routine exposures to air pollution from both household and outdoor sources.

While this was a first, our health-focused message was glaringly absent from the mainstream COP agenda at that time. Fast forward to 2023, and thankfully, the healthcare community is no longer sitting on the sidelines of the climate conversation. 

In fact, this year’s COP28 UN Climate Conference features a health and climate ministerial as well as a dedicated WHO Health Pavilion, which aims to incorporate health concerns into climate negotiations. 

The speakers are armed with a growing array of data about the 7 million lives lost yearly from air pollution — much of it generated by the same sources that drive climate change.  Additionally, the latest IPCC report has projected some 9 million deaths annually by the end of the century from climate change-driven extreme heat, infectious diseases, and malnutrition in a business-as-usual scenario.

Public health professionals also are joining the larger discussion. Even so, health professionals may struggle with the contribution that they can make to the debate. 

While the health sector is looking at new ways to clean up its own carbon emissions, estimated to be about 5% of the global total, it cannot dictate policies on energy, transport, agriculture and building sectors that contribute the lion’s share to climate change today. 

So how can the health care community continue to expand its role in accelerating climate and clean air action? Here are some concrete examples of actions that healthcare professionals can undertake.

They are drawn from settings as diverse as Kampala, Uganda;  Accra, Ghana and Indore, India among others, and offer a kind of ‘proof of concept‘ about the role the health sector can play. 

These stories illustrate three main arenas in which the health sector can make significant contributions on the front lines, in policy circles and in more linked-up health and environment data collection and analysis.

Raising awareness and reducing risks on the front lines of care

Air pollution looms over New Delhi, November 2023.

Visits between patients and their primary healthcare providers are the most crucial touch point in the chain of outreach for healthcare services generally. In terms of the intersection of health and climate, these contacts are being mobilized to build awareness as well as minimize peoples’ exposure to both climate and air pollution risks.  

In Indore, ranked as India’s cleanest city, ASHAs are now being trained to provide guidance to their patients on minimizing their exposure to leading pollution sources, such as traffic, the open burning of waste, and cooking over open wood fires. These contacts can most frequently happen when patients seek medical attention for conditions such as asthma and pneumonia, which have clear air pollution triggers.

A continent away, community health officers across East Africa have learnt how to use messages on clean air as a strategy to promote health. In the Ugandan capitol of Kampala, they have been instrumental in a campaign to discourage open waste burning. 

Linked up health and climate policymaking 

A man from Ghana burns electronic waste to reveal the metals at the Agbogbloshie electronic waste site in Accra, Ghana (2018).

At the policy level, even more potential exists to build a united front between the health and climate sectors, which emphasizes the health gains and avoided health costs of action. . Demonstrating the lifesaving capacity and cost-saving potential of climate and environment action through the lens of health can turn the tide on empty pledges and quicken measurable improvements.  

In Ghana’s capital,  Accra, an Urban Health Initiative launched in 2016 by the Ministry of Health, Ministry of Environment, and metropolitan authorities, with the support of the UN agencies, had the explicit goal of increasing awareness of the benefits of health-driven clean air policies. 

The work included mapping the policies and stakeholders concerned with Accra’s air quality and then, sector by sector, developing plans for alternative means of powering homes and businesses, managing waste, and making transport more eco-friendly. 

Multiple policy recommendations made by the Urban Health Initiative were ultimately implemented as part of Accra’s ongoing urban planning strategies. Even more profoundly, the credible evidence provided by the health sector on both the health impacts of the status quo and the health benefits of greener development alternatives helped cement a shared understanding of linked problems and solutions.

More data, more awareness and better solutions  

Uganda
Kampala, the bustling capital city of Uganda, is home to 1.5 million people. Air pollution claims 28,000 in the city lives every year.

What binds this all together is the availability of data. Good data informs strategy and provides convincing evidence for politicians to act.

This has been evident not only in Ghana but also in the experiences in Uganda, a nation where an estimated 28,000 people die annually as a result of air pollution. 

In 2021, Kampala’s city authority released details of a three-year Clean Air Action Plan that was anchored by investments in low-cost air-quality monitoring stations to deliver real-time data. 

That data then activates health experts in the region, who know exactly where and how to disseminate messaging around local blights like waste burning as well as the importance of clean air, generating a groundswell of public support for more action. 

As a result of the monitoring programme,  Uganda’s National Environment Management Authority has now developed standards for ambient air quality across the country. 

The Kampala Capital City Authority can, in turn, cross-reference the data from monitoring stations against the Environment Management Authority’s regulations and use that to guide enforcement and accountability.

Crucially, the Capital City Authority has begun hosting events such as the 2023 Car-Free Day alongside partners from Kampala’s  Environment Management Authority and the national Ministry of Health to emphasize the symbiosis between cleaner air and longer, healthier lives.  

The good news is that even if they are not attending COP, the world’s health workers can still contribute to addressing the inextricable link between our health and that of our planet. 

This includes lobbying for effective legislation to reduce carbon emissions and protect our ecosystems from pollution; training frontline workers and clinicians to raise awareness and reduce environmental health risks among their patients; and supporting linked-up health and environment data collection and analysis.  Progress necessitates all three. 

About the authors

Sumi Mehta is the vice president of environmental and climate health at Vital Strategies. 

Daniel Okello Ayen is the Director of Public Health and Environment at Kampala Capital City Authority.

Image Credits: Jean-Etienne Minh-Duy, EPA/CHRISTIAN, Angella Birungi.

The global health community must stop treating water, sanitation and hygiene (WASH) as a little issue because it is not, according to Annie Msosa, the advocacy advisor for WaterAid in Malawi.

Speaking to Garry Aslanyan on the most recent episode of the Global Health Matters podcast, she said that “governments are spending on WASH… They are spending more right now on treating the effects of the lack of it. But we need them to spend more on actually sorting it out.”

WHO: 1.4 million people died in 2019 due to inadequate water, sanitation and hygiene resources

In the current age of artificial intelligence and rapid technological and scientific progress, some 1.8 billion people worldwide still lack the fundamental luxury of access to running water in their homes, according to Aslanyan. Furthermore, an alarming 3.4 billion individuals are deprived of proper sanitation facilities. According to the World Health Organization, the consequence of this dire situation is the tragic loss of 1.4 million lives in 2019 due to inadequate WASH resources.

The lack of safe water and sanitation leads to the transmission of disease and increased antimicrobial resistance.

For women, specifically, the impacts can be huge. Globally, around 77 million days are lost by women just in time spent to fetch water, Msosa said. This has an effect on their livelihoods, productivity and mental health.

For pregnant women, the problem is even more acute. Physically, walking long distances and carrying heavy buckets of water can lead to spinal injuries, hernias, and genital prolapse, and it can also increase cases of spontaneous abortion in pregnant women.

Moreover, 90% of frontline healthcare workers are women, meaning they are significantly exposed to this issue.

“They cannot do their job properly, and it’s frustrating,” Msosa said. “It brings mental health issues because you want to help, but people are dying because you did not have all the tools, basic tools that you need for you to deliver a quality service to your patients.”

David Wheeler, the executive director of the Reckitt Global Hygiene Institute in the United States, who also joined the show, said that his team is looking “to build more collaboration across the NGOs, the charitable organizations and the academic community” to help solve the WASH challenge, “to answer a lot of the questions that are coming up that seem to be roadblocks to implement programs or to achieve better funding levels or to start programs and secure additional funding for WASH-based interventions.”

Msosa: Time to look at WASH differently

Msosa said that it is time to look at the problem of WASH differently and to be able to determine what the investment that is needed now is going to save a lot of lives and also money that would otherwise be spent treating diseases that could have been prevented.

“Health investment tends to be disease-focused, and WASH is not a disease, even though it impacts so many diseases,” she said.

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

Image Credits: Global Health Matters.

The United Arab Emirates, host of COP28, announced $1 billion in new funding from 124 countries for ‘Climate and Health’. The United States and India are not taking part.

DUBAI, UAE – In what is being described as a historic and pivotal moment by top COP28 and World Health Organization (WHO) officials, 124 countries have endorsed the Declaration of Climate and Health. Dr Sultan Ahmed Al Jaber, President of COP28 in Dubai, made the announcement.

“We have received commitments from 123 countries that are ready to sign the health declaration,” Al Jaber said Saturday. “That is a big achievement. It is a giant leap in the right direction.” China reportedly committed to the declaration shortly after Al Jaber’s remarks, bringing the informal tally as of 2 December to 124 countries. 

The political declaration marks the first time that the health impacts of climate change have taken centre stage in 28 years of UN climate talks. The United States and the European Union headline the list of signatories along with wide swathes of Latin America, leading north African and east African nations, such as Kenya, as well as Nigeria. India and South Africa, however, had not signed at the time of publication.

While the declaration is not legally binding, the declaration serves as a voluntary call to action outside the formal process of the United Nations Framework Convention on Climate Change (UNFCCC).

Reem Ebrahim Al Hashimy, Minister of State for International Cooperation in the UAE’s Ministry of Foreign Affairs, expressed hope that the declaration would dispel any lingering doubts about the health crisis posed by climate change.

“I believe we now have the basis within the COP process to move to a greater scale and greater impact and to end any silly confusion about whether the climate crisis is a health crisis,” said Al Hashimy. 

‘Initial tranche’ of $1 billion announced

World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus addresses COP28 after Al Jaber announced the Health & Climate declaration.

The UAE announced an “aggregated” financing commitment of $1 billion, facilitated by the Green Climate Fund, the Asian Development Bank, The Global Fund, and the Rockefeller Foundation. Al Hashimy described the funding as “an initial tranche” intended to back up the political commitments made by the 124 signatory nations.

This financing will be crucial, particularly for low- and middle-income countries. The declaration underscores the need to “better leverage synergies at the intersection of climate change and health to improve the efficiency and effectiveness of finance flows.”

“Finance for climate and health unlocks action which benefits both people and the planet,” said Jess Beagley, Policy Lead at the Global Climate and Health Alliance. This $1 billion sum is a tremendous addition to current levels of climate and health finance.” 

The declaration calls for climate action to achieve “benefits for health from deep, rapid, and sustained reductions in greenhouse gas emissions, including from just transitions, lower air pollution, active mobility, and shifts to sustainable healthy diets.”

However, the health declaration does not mention fossil fuels, a contentious issue for several governments, despite overwhelming and conclusive evidence that global warming is caused by the excessive burning of fossil fuels.

Fossil fuels are not the only notable exclusion. Two of the top three greenhouse gas emitters, the United States and India, are absent from the list of 124 nations that endorsed the declaration.

Chinese President Xi Jinping and US President Biden, leaders of the world’s two biggest polluting nations, will not attend the Dubai conference. Prime Minister Narendra Modi attended COP28 on December 1 and expressed India’s interest in hosting COP28 in 2028.

COP28 President Al Jaber expressed optimism that more countries would join the initiative.

“We continue to engage and ask many others to sign up. Those who have not signed up already have given me the right signals and positive responses that they will be signing up soon. I’m very much counting on them coming on board,” he stated.

Today’s announcement comes on the eve of a high-level meeting of health ministers and other officials in Dubai to discuss the health impacts of climate change. This ministerial meeting is expected to mark the first formal step towards including health in the COP process.

The climate crisis is a health crisis

COP28 President Dr Sultan Al Jaber announced the Climate and Health Declaration on Saturday.

The global health community, which has advocated for decades for climate change to be recognized as a health crisis, welcomed the endorsement of the Declaration of Climate and Health as a landmark moment.

“This is the realization of a dream for which the global health community has been fighting for years,” said Dr Maria Neira, who leads the WHO’s Department of Environment, Climate Change and Health  “The climate crisis is a health crisis.”

Mafalda Duerte, Executive Director of the Green Climate Fund, warned of the potential for climate change to disrupt healthcare systems even more severely than the COVID-19 pandemic. “What’s coming because of climate is something we don’t fully understand,” she said.

Dr. Rajiv J. Shah, President of The Rockefeller Foundation, commended the financial commitments made to support climate and health initiatives. “Our foundation will commit $100 million going forward to climate and health,” he stated.

The WHO’s Dr Maria Neira, who leads the UN health body’s Department of Environment, Climate Change and Health, described the declaration as the realisation of a dream for which the global health community has been fighting for years.

COP28 crossroads

The average daily global temperature shattered the 2°C above pre-industrial level mark for the first time on November 17, according to the European Union’s Copernicus climate change service.

COP28 is considered the most crucial climate conference since the Paris Agreement in 2015. While the Paris Agreement secured global recognition of the need to limit global warming to 1.5°C above pre-industrial levels, the Dubai conference will require governments to reassess their Nationally Determined Commitments (NDCs) based on the findings of the first Global Stocktake (GST). 

Scientific assessments from the Intergovernmental Panel on Climate Change (IPCC), the United Nations Environment Programme (UNEP), GST, and other expert bodies show that the current climate policies announced and enacted by governments are far too little to address the climate crisis.

The current trajectory of global emissions is headed towards warming of nearly 3°C by the end of the century. The big question over the next ten days in Dubai is whether countries will step up their climate commitments and agree on climate finance to accelerate the transition to a low-emission global economy.

The United States is reportedly set to pledge $3 billion to the GCF at COP28. US Vice President Kamala Harris is expected to announce the pledge during her address to the conference.

Transitioning the world to a green global economy and supporting adaptation efforts in countries vulnerable to climate change is estimated to require trillions of dollars.

Editor’s note: In an earlier version of this story, Health Policy Watch erroneously reported that the United States of America had not signed onto the Health and Climate declaration, when in fact they were one of its early supporters.  We regret the error. 

Dharriwaa Elders Group staff and Elders protesting the need to buy bottled water given the poor quality of Walgett’s tap water.

A project born from community advocacy and Indigenous leadership has catalysed a unique partnership between a small, rural Australian community and global health experts, shining a light on the link between climate, health and the power of community-driven change.   

Systematic water mismanagement combined with droughts and floods exacerbated by climate change has led to unreliable town water supplies for residents of Walgett in New South Wales.

Early this year, a survey led by local Aboriginal community-controlled organisations conducted in the Aboriginal community found that 43% of people were experiencing moderate to severe water insecurity. The drinking water supplied to the town from bores was found to be so high in sodium that it posed a threat to the many community members living with high blood pressure, heart disease, kidney disease and diabetes.

The survey showed the levels of water insecurity in Walgett were even worse than those recorded in Bangladesh’s capital, Dhaka; a city of 23 million people struggling to cope with the impacts of extreme heat. A rise in the salinity of drinking water in Bangladesh has been linked to increases in hypertension and chronic kidney disease and elevated rates of pre-eclampsia and gestational hypertension in pregnant women.

The George Institute partners with communities in both these contexts, and we are keenly aware that for the people most impacted by the interlinked threats of environmental change and chronic disease, the climate crisis is a health crisis and vice versa.

Indeed, to separate the two is incompatible with Indigenous peoples’ holistic understanding of health, which encompasses not only the physical, social, emotional and spiritual well-being of the whole community, but also its connection to Land and Country, including the earth, waterways and skies.

As we prepare for the first-ever ‘Health Day’ at this year’s UN Climate Change Conference (COP28) in the United Arab Emirates, we argue that progress in breaking down siloes between climate and health is welcome, but far too slow. To accelerate urgently needed inter-sectoral action, we need to put affected communities at the heart of decision-making processes.

Integrating climate in health priorities

WHA76
World Health Assembly 76 in progress.

At the World Health Assembly in May, the climate crisis made an appearance in several official agenda items, as well as multiple side events.

The links between environmental change and health were at least nodded to in resolutions to address the health challenges faced by Indigenous peoples; the burden of drowning; and actions for the prevention and control of non-communicable diseases. In addition, the first-ever resolution on the impacts of chemicals, waste, and pollution on human health was approved at the Assembly – ironically, without naming fossil fuels. 

The integration of environmental considerations across multiple health priorities was a positive step, as is progress towards the adoption of a resolution on climate change and health in 2024, supported by the Global Climate and Health Alliance and partners. Nevertheless, the visibility of the climate crisis at the World Health Assembly was by no means congruent with its status as one of the greatest threats to health this century. 

Integrating health in climate priorities

World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus delivered his first speech at COP28 on the eve of ‘Health Day’, which will take place on December 3.

The inclusion of a ‘Health Day’ on this year’s COP agenda aims to signal a shift in focus, highlighting the recognition of health as a central pillar in climate discussions at the highest level.

Last year’s conference laid some foundations to build on. For example, with the launch of the Sharm El-Sheikh Adaptation Agenda, which aims to enhance resilience for four billion people living in the most climate-vulnerable communities by 2030.

This year, a set of new ‘Health Outcomes’ will be integrated into the Agenda, comprising a plan to address the increasing impacts of climate change on human health and health systems. COP28 will also feature a Health Pavilion for the third time.

In addition, COP28 will see the inaugural Health and Climate Ministerial meeting, at which governments will be asked to endorse a Declaration on Climate and Health. The Declaration has been developed with the WHO, and is ‘intended as a clear signal of ambition and unity on health’, according to the COP28 Presidency.

However, the Declaration is a voluntary call to action which sits outside the formal conference negotiations, raising concerns that it may become just another commitment for which governments can’t be held to account. It also overlooks the importance of reducing emissions to limit health hazards and alleviate pressure on strained health systems.

Communities as catalysts for integrated approaches

Yuwaya Ngarra-li is a community-led partnership between the Dharriwaa Elders Group, an Aboriginal Community Controlled Organisation working for cultural management and community development in Walgett for more than 23 years, and partners at the University of New South Wales.

There will likely be many more health-focused civil society organisations at COP28 than there were climate-focused groups at the World Health Assembly. However, there is still much room for greater intersectorality in advocacy, as well as policymaking. For example, those seeking tighter regulation of fossil fuels may have something to learn from advocates with decades of experience in battling tobacco and other health-harming industries. 

However, to really shift the dial on intersectoral action, we need to centre the voices of people who are experiencing every day the dire health consequences of environmental degradation; from increased heatwaves to the spread of vector-borne diseases, from failed food systems to rising drinking water salinity.

Moreover, it is imperative that we hear from and listen to Indigenous voices, which are often relegated to the margins yet hold sophisticated knowledge in climate mitigation and adaptation strategies that are land-informed, community-driven and holistic.

Through the Yuwaya Ngarra-li partnership between the Walgett Dharriwaa Elders Group and UNSW researchers, advocacy around ongoing water crises and the important cultural connection to Country (lands and waters) has led to significant media coverage and a ministerial commitment to a long-term water solution.

The partnership has also led to innovative, community-driven actions, including the employment of a local food and water coordinator, the installation of a safe drinking water kiosk by the Dharriwaa Elders Group, and a drought-proof micro-farm at the Walgett Aboriginal Medical Service.

In Bangladesh, as part of our work on non-communicable diseases and environmental change, we are in the process of setting up a Public Advisory Board, as we have in India and Indonesia. Comprised of members with diverse backgrounds and lived experiences, the Board is a platform for community members to provide input and participate in decision-making processes. ensuring that their voices are prioritised in shaping interventions to reduce water salinity.  

Further examples of putting community voices at the heart of discussions to set policy agendas and allocate resources can be found in ongoing efforts to establish mechanisms for social participation in health, and the critical role played by communities in progress towards ending AIDS. 

Success will be rewarded with intersectoral policies and services that build on the Traditional Knowledges of Indigenous peoples and respond to community needs; particularly those of women, girls, young people and other groups who experience the impacts of the climate crisis disproportionately.

By mobilising local communities as communicators, advocates and agents of change – from Australia to Bangladesh and beyond – we can prioritise action that directly improves health outcomes for both people and planet, ensuring a more equitable and resilient future for us all.

About the authors

Chhavi Bhandari is the head of Impact and Engagement for India and Multilaterals at The George Institute for Global Health, working from India on a programme of multilateral, regional and national advocacy and engagement. She is the Community Engagement and Involvement (CEI) lead for the National Institute for Health and Care Research (NIHR) Global Health Research Centre for Non-Communicable Diseases (NCDs) and Environmental Change and a member of the WHO-Civil Society Working Group to Advance Action on Climate & Health.

Keziah Bennett-Brook is a Torres Strait Islander woman and Program Head of Guunu-maana (Heal) Aboriginal and Torres Strait Islander Health Program at The George Institute for Global Health, Executive Member of the Australasian Injury Prevention Network, and Indigenous Committee lead. Keziah has chaired the Research Committee for Aboriginal and Torres Strait Islander Health since 2017 and leads the development and implementation of Aboriginal and Torres Strait Islander health research strategy, policy, stakeholder partnerships and Indigenous research coordination within a global research institute. 

Emma Feeney is the Director of Impact & Engagement at The George Institute for Global Health, where she leads a global programme of activities including advocacy, policy engagement and thought leadership to help increase the impact of the institute’s health and medical research. Emma co-chairs the WHO’s NCD Lab on Women and Girls and the NCD Alliance Supporters’ Group.

Full house at the opening of CPHIA2023

LUSAKA, Zambia – The silver lining to Africa being denied access to COVID-19 vaccines during the pandemic is how it has galvanised continental leaders to focus on self-reliance – instead of depending on wealthy countries for assistance.

The determination to build the continent’s health systems capacity was abundantly evident at this week’s Conference on Public Health in Africa (CPHIA) hosted by the Africa Centres for Disease Control and Prevention (Africa CDC).

“Having a major conference like CPHIA on the continent here in Africa means that we can change the narrative. It means that we can lead the conversation. We can change it by centring what matters most to African communities and spotlighting extraordinary science from African researchers that would normally go unnoticed,” said Shingai Machingaidze, Africa CDC’s acting chief scientist and a rising star in global health.

Shingai Machingaidze, Africa CDC’s acting chief scientist

“There have been concerns raised about access and representation at global health conferences and meetings, and many of our African leaders have raised these concerns, including visa challenges,” Machingaidze added in an address to the conference’s closing plenary on Thursday.

It is often extraordinarily difficult for African scientists to get visas for North America and Europe, even when their papers have been accepted at international conferences.

The Africa CDC – which was only launched in 2017 – won the respect of member states for how hard it fought for the continent during the pandemic.

This support was reflected in the fact that conference attendance surpassed the body’s expectations by over 1000 delegates – attracting 5,100 delegates in-person and 30,000 online – double that of the first in-person CPHIA in Rwanda last year.

CPHIA2023 summary

Multiple disease outbreaks

The obstacles are huge. Africa has already experienced 158 health emergencies this year alone, of which 90% were infectious diseases and three-quarters were zoonotic diseases (passed on from animals), according to Dr Merawi Aragaw Tegegne, Africa CDC’s head of surveillance and disease intelligence.

One new pathogen a year has emerged on the continent for the past 30 years – again, three-quarters from animals – adding to the already daunting stack of threats, Merawi told the conference.

African countries are ill-prepared for pandemics, scoring an average of 29.1 out of 100 in the Global Health Security (GHS) Index.

None of the continent’s 55 states scored over 20% for biosecurity, and only two countries – Kenya and South Africa – scored over 50% for biosafety capacity, revealed Dr Talkmore Maruta, director of programmes at the African Society for Laboratory Medicine.

Many countries simply lack the capacity to comply with international agreements, including the World Health Organization’s (WHO) International Health Regulations (IHR) and the United Nations Biological Weapons Convention.

The biggest obstacles are the shortage of appropriately trained staff, lack of resources, and inadequate or unclear regulations.

There are also tussles between government departments – primarily defence, health, environment and agriculture – about who should take control of biosecurity when the legal framework should ensure shared responsibility, according to Maruta.

Preparing for climate crises

A submerged house in Nsanje in Malawi after Cyclone Freddy.

But the continent is not only threatened by diseases. Africa is particularly vulnerable to extreme weather events, and Africa CDC believes that “climate change poses the biggest health threat” this century.

“As I speak, we have 18 countries affected by cholera with more than 4,000 deaths,” Dr Jean Kaseya, Director General of Africa CDC, told the conference.

“We have multiple West African countries affected by dengue. The flooding in a number of countries including Libya, the earthquake in Morocco, and a number of other natural disasters, are showing the linkage between climate change and health in Africa,” said Kaseya. 

When Cyclone Freddy battered Mozambique, Madagascar and Malawi in February, the devastating storm was followed by the largest and most deadly cholera outbreak in Malawi’s history. Mozambique and Madagascar were not spared either, as massive flooding displaced millions and destroyed primary health care services across the two countries. 

Yet many health officials are so overwhelmed with current diseases that preparing for climate change seems “futuristic”, according to Dr Eduardo Samo, Director General of Mozambique’s National Institute of Health.

He appealed for fragile health systems to become resilient to extreme weather events, particularly at the community level, added Samo.

 “This can be a simple thing like making sure that the roof of a health facility is built so that it does not get blown off and the facility is flooded during a storm,” he explained.

Under-funded and under-skilled health workforce

The 55 African states spend an annual average of $50 per person on health – far too little to cover all people’s health needs. In addition, their already vulnerable health systems were severely affected by COVID-19.

Back in 2001, African Union members committed to allocating at least 15% of their budget each year to the health sector in what became known as the Abuja Declaration. Virtually none have done so.

But Sara Hersey, director of collaborative intelligence at the WHO’s Hub for Pandemics and Epidemic Intelligence in Berlin, says that there have been significant improvements as a result of COVID-19.

The pandemic brought “an influx of capacity, support and focus on health security”, said Hersey.

“We’ve seen substantial changes in the capacity for surveillance. Risk communication has improved dramatically as has health service provision and health emergency management,” she said.

“We need to keep this momentum and sustain the capacity that we have already built. Critical to this is the role of the national public health agencies, including national health institutes, CDCs and institutes that lead pandemic preparedness and response.”

Since 2017, 18 African countries have established national public health agencies or are in the process of doing so – including even one of the continent’s poorest countries.

New public-private collaborations

‘Saving Lives and Livelihoods’ is a collaboration between Africa CDC and the Mastercard Foundation to improve pandemic preparedness.

While money is always a challenge, several promising collaborations have emerged.

Earlier this year, Africa CDC and the WHO’s Africa (AFRO) and Eastern Mediterranean (EMRO) regions launched a Joint Emergency Preparedness and Response Action Plan (JEAP) to address emergency preparedness and response in Africa. 

JEAP outlines the responsibilities of each organisation – significant due to the past history of territorial disputes between Africa CDC and the two WHO Regional Offices that manage WHO operations in the sub-Saharan and north African regions of the continent respectively.  JEAP furthermore outlined six areas of collaboration, including assistance to countries with genomic sequencing, stockpiling of emergency supplies, and workforce readiness and deployment.

Meanwhile, the Mastercard Foundation announced at the conference that it was entering the second phase of its $1.4 billion collaboration with Africa CDC to better prepare countries for the next pandemic. Phase 2 of the joint ‘Saving Lives and Livelihoods’ collaboration will focus on completing the vaccination of healthcare workers and vulnerable groups, training community health workers, bolstering national public health institutions, laboratory capacities and local manufacturing of vaccines, therapeutics and diagnostics.

Earlier this month, Africa CDC also announced that had set up a continental structure to train and integrate two million community health workers into national health systems.

In 2022, the African Union (AU) resolved to set up an Africa Epidemics Fund, and this is expected to be launched in February 2024, according to Devex. South Africa’s President Cyril Ramaphosa is the continent’s pandemic envoy and is expected to spearhead the fundraising for this.

The US government is also supporting continental pandemic preparedness efforts.

Partnership for African Vaccine Manufacturing ramps up ambition

Meanwhile, the Partnership for African Vaccine Manufacturing (PAVM) is driving the continent’s lofty ambition to rapidly ramp up vaccine, medicines and diagnostic production. At the start of the conference, Kaseya described the African Union’s ambition to produce 60% of the vaccines that it needs on the continent by 2040 as “the second independence” for the continent.

“Many African countries got their independence [from colonisers] in the 1960s, but we saw in COVID that we are not independent,” Kaseya told a media briefing at the start of CPHIA. “Other continents locked their doors and we were left beyond.”

The glaring inequity that emerged during the pandemic has galvanised the African health sector and donors, while the current WHO negotiations for a pandemic treaty are keenly focused on equity measures.

At the close of the conference co-chair Professor Margaret Gyapong stated: “Collective leadership is critical to fight the next health crisis. Listen, trust each other, and work together. We have the tools and we must use them now. And yes, invest in women.” 

Heatwaves and air pollution exacerbate existing chronic diseases and cause new ones, worsening the noncommunicable disease (NCD) burden, experts at COP28 said.

As the world continues to burn fossil fuels, heatwaves and air pollution are getting worse, and increasing the pressure on human health. This is exacerbating the burden of non-communicable diseases (NCDs), which comprise the lion’s share of the world’s disease burden, experts at COP28 said on the opening day of the summit on Thursday.

“We all know that climate change is a health crisis. But if you combine this with NCDs, this is certainly a double crisis,” said Bente Mikkelsen, director of the Department of NCDs at the World Health Organization (WHO). She was speaking at an event on the COP28 sidelines called, “Unbearable Heat, Unbreathable Air – Finding Win-Win Solutions for Climate and Health.”

Deaths from non-communicable diseases comprise 75% of premature mortality (under age 70) globally. This number is only increasing as the world’s population ages, Mikkelsen noted. But most people don’t understand how global warming or what UN Secretary General Antonio Guterres called “global boiling” is adding to the NCD burden in multiple ways, she added.

Many NCD conditions, from kidney disease to cardiovascular conditions, are exacerbated by extreme heat exposures, Mikkelsen explained. While heatwaves killed 60,000 people in Europe alone in 2022, the global toll is not well known due to data gaps.

The combined death toll from heatwaves, vector-borne disease, and malnutrition could cause up to nine million deaths by the turn of the century, WHO has said based on assessments by the Intergovernmental Panel on Climate Change.

Air pollution is estimated by WHO to kill seven million people annually, although research published this week in The BMJ put the number much higher at 8.34 million deaths for outdoor air pollution alone.

This air pollution is caused by the same sources driving climate change – the burning of fossil fuels, waste, as well as heating and cooking with coal, kerosene, and biomass in traditional stoves.

“It is probably not that well known that 85% of air pollution [mortality] again, is attributed to non-communicable diseases,” Mikkelsen said, referring to the cardiovascular, respiratory, and cancers that are recorded as causes of death.

Bente Mikkelsen of the WHO said the worsening heat waves and air pollution, both a result of the changing climate, are worsening the NCD burden. This means the world is not on track to reducing the NDC burden by a third by 2030 which is the Sustainable Development Target, she said.

Health is not a formal part of the UN Climate process 

DUBAI, UAE -Despite being a pillar of the 1992 UN Framework Convention on Climate Change, health has never been a formal part of the agenda of UN Climate negotiations or the Conference of Parties (COP) process.

This year, health has gained a foothold as a COP thematic day, December 3, during which 63 health ministers are expected to arrive in Dubai. This is the first-ever such gathering at a climate conference.

While this may be an important symbolic event, climate change, air pollution, and the NCD epidemic – all major crises in themselves – need to be much more deeply interlinked, experts said.

Far more needs to be done to promote “integrated” solutions that also prevent global temperatures from exceeding the limits of human survivability across large swathes of the planet, experts at the side event, co-sponsored by the World Health Organization, the World Bank and the Clean Air Fund, said.

They called for a reduction in fossil fuel burning and subsidies to the industry along with increased investments in renewable energy broadly and within the health sector.

More formal moves to include health-related indicators and objectives in climate policies could also help the world meet a wide range of the 2030 Sustainable Development Goals, from reducing NCD deaths (SDG3) to healthier cities (SDG 11) and clean energy for all (SDG7), said panellists at the event, which was held at the SDG Pavilion.

Using clues from human physiology to improve climate strategies

Tony Capon from Monash University said the conversation on reducing the impact of heat needs to account for human physiology as well which is currently missing in the conversation.

“It’s likely that we’re under-estimating the thresholds [of heat tolerance] because we aren’t bringing human physiology into the discussion, because we all have different responses to extreme heat. Perhaps we have a non-communicable disease. Perhaps we’re aging and we’re more at risk,” Tony Capon, of Australia’s Monash University, a member of the World Meteorological Organization’s Heat and Health Network, said.

Tolerable levels of heat vary widely with the level of ambient humidity and ventilation, he pointed out, referring to the body’s sweat response. Simply moving air around with a fan can also cool people down, allowing them to tolerate higher temperatures safely.

Air conditioning, whose use is soaring in hot countries, is a “maladaptive response” to climate, said Capon. Not only does it increase carbon emissions, but it pushes hot air out of the homes and offices of the wealthy and out into the streets and neighbourhoods of the city, exacerbating the urban heat island effect for poorer communities and vulnerable groups.

Air pollution and heat wave deadly synergies  

A dense toxic smog in New Delhi blocks out the sun. (8 November 8, 2017).

Policymakers also need to pay closer attention to the interplay between air pollution and heat, Capon added.

“When we think about air pollution and heat together, our body’s response to heat can actually exacerbate the health impacts of air pollution. Because we breathe more deeply when it’s hot. And that means we breathe the pollution more deeply into our lungs, our hearts also working harder. And so it’s pumping those pollutants around our body more than it otherwise would be if it wasn’t a hot day,” he explained.

Based on such basic knowledge, health and climate actors can build more integrative solutions if they look at the full spectrum of health impacts from proposed climate strategies, he said. That also means focusing not only on greener energy but on investments in more low-carbon buildings, with good ventilation and on more sustainable cities and transport systems.

Solutions: Renewables, multisectoral response and finance

A traditional brick factory in Tozeur, southern Tunisia. In Africa and South Asia brick making and waste burning are major sources of air pollution.

More sustainable solutions also need finance, and that’s still sorely lacking, said Arunabha Ghosh, CEO of India-based think tank Council on Energy, Environment and Water (CEEW). He noted that while Africa has vast solar energy potential, only 2% of climate finance is invested in the continent.

Multiple barriers are stifling Africa’s green energy expansion. Most climate finance supports mega energy projects, while much of Africa’s entrepreneurship is small and medium businesses. Smaller, distributed grid energy projects would be more suitable to many underserved communities, far removed from big cities but these are not getting the required attention currently. Countries where credit ratings make them poor bets for investors often are the most in need of these investments.

However, there are some hopeful signs of change, Ghosh said, noting that the World Bank was in a “seminal moment” in terms of prioritizing its climate and air pollution policies.

“If we can have air quality as one of those global challenges around which new programming for the World Bank will emerge, I think that really gives us a leg up,” he said. “We’ve got to start thinking about the linkages between health, the economy, climate and the broader SDGs as part of that new economic paradigm. And then look at the hierarchy of solutions.”

Providing further details on some of the new investment trends, the World Bank’s Jostein Nygard described moves afoot in Southeast Asia to support countries’ investment in air pollution solutions.

World Bank initiatives on better air quality involving South Asian countries along the Indo-Gangetic Plain and Himalayan foothills.

One key focus of that initiative is the heavily polluted Indo-Gangetic plain and Himalayan Foothills region, which extends from Pakistan across northern India and southern Nepal to Bangladesh. South Asia suffers from some of the heaviest air pollution in the world, with an estimated 4 million deaths annually from air pollution across countries in the region.

Bringing the environment and health departments of the countries to work together has been a challenge, but things are improving.

“We can now see that we gradually are getting an entry point that we need to further enhance the collaboration between environment and health,” Nygard said. “We are pretty optimistic about being able to move this process forward.”

Tax the windfall profits of the oil and gas sector to fund health facilities

Salvatore Vinci, an energy advisor to the WHO said that fossil fuel profits should be taxed to support investments in renewable energy and bring electricity to the one billion people around the world who live without it.

Along with speaking out more forcefully about health and climate harmful policies in other sectors, the health sector can also show the way by shifting health facilities to renewables, Salvatore Vinci, an energy consultant for WHO, said.

He noted the recent WHO findings that nearly one billion people in lower-income countries lack access to a health facility with adequate energy infrastructure to power basic health services, he pointed out. An estimated 450 million people worldwide lack access to a health facility with any electricity at all.

Many health facilities in low-income countries are heavily reliant upon diesel fuel or expensive and unreliable grid conditions, he said, noting that in Somalia, the cost of electricity is $1 per kilowatt hour and in Yemen, the cost of diesel is $1.14 per litre of diesel. Those costs could be reduced by two-thirds if renewable power was installed, he said.

“Africa is the place with 60% of the best solar resources, but there is 1% of the solar installation,” Vinci said. “So we will talk about electricity and energy transition first, let’s talk about the most vulnerable population,”

The scale of investments needed is large, but they pale when compared to the profits the fossil fuel industry is making, he pointed out. “In 2022, the global oil and gas industry made a profit of $4 trillion, more than doubling the income of the previous years,” said Vinci. “If we have to electrify all the healthcare facilities in the world, we would need just $4.9 billion.”

See related story: COP28: Will a Petrostate Lead the Fight Against Climate Change?

Image Credits: Unsplash, Wikipedia, WHO/Diego Rodriguez.

HIV activists protesting against patent laws that pushed up costs of essential medicines in Cape Town in  2014.

I endured a dreary weekend in a Paris hotel while others rushed home. As the junior English speaker of a task force of United Nations (UN) member states, it fell to me to finalise our report. It was the early 1990s and we had travelled across Asia, Africa and Latin America collating confusing evidence and conflicting opinions that now required urgent synthesis and circulation to the world.   The question before us concerned the relatively new HIV/AIDS.

Incontinent patients overflowing Malawian hospitals, mountains of roadside coffins in Uganda, lost orphans in Johannesburg, emaciated drug users under Beijing flyovers, terrified migrants in Mumbai slums, panic-stricken sex workers in Nairobi, stigmatised gay men in Rio de Janeiro, contaminated blood recipients in New York, and later, raped women from the Rwanda genocide. These were some observations from the first-ever task force world tour of the HIV scourge.

Alongside unpicked harvests, collapsed businesses, and infected armies destabilising nations. It convinced us that the business-as-usual mode of UN agencies would not do. 

But what might a transformed global AIDS effort look like?  There was unanimity that a whole-of-society approach was urgent. Our findings led to the 1993 World Health Assembly and 1994 UN Economic and Social Council resolutions. The Joint United Nations Programme on HIV/AIDS (UNAIDS) duly opened its doors in 1996. 

HIV probably originated early in the 20th century by jumping from apes to humans in Africa and spread slowly through travel. The virus was identified in 1983  as the epidemic got going. Since then, 86 million people have been infected and 40 million have died. 

Remarkable struggle against HIV

Community Health Workers attend a training session on HIV in Kirehe, Rwanda.

The forty-year struggle against HIV/AIDS has been remarkable. It sparked unprecedented global unity that we can only envy nowadays – with numerous UN resolutions including unanimous support at the Security Council in 2000, the first time a health matter reached so high.   

HIV stimulated unprecedented institutional innovation.  UNAIDS pioneered UN reform with 11 quarrelsome UN agencies joining hands. It made consultation fashionable and welcomed civil society, including patient groups, onto its governance. Unprecedented generosity was unleashed with the 2002 formation of the Global Fund’s dedicated financing channel for HIV/AIDS, tuberculosis and malaria.  The bilateral US President’s Emergency Plan for AIDS Relief (PEPFAR) was formed in 2003. 

HIV turbo-charged research with the first antiretroviral treatment becoming available in 1987, averting 21 million deaths till now.  Subsequent therapeutic advances including post-exposure prophylaxis turned HIV from an assuredly fatal condition to one that causes less than one death per 10,000 population. 

Prevention – a controversial matter of sexual abstinence, condoms, and clean needles –  got a boost in 2012 with pre-exposure prophylaxis alongside a revolution in diagnostics including tracking the immune status of patients.

Nowadays, treated HIV is akin to a chronic disease with almost normal life expectancy.  Although the holy grail of an HIV vaccine remains elusive, promising innovations underway include six candidate vaccines in Phase 1 clinical trials. The benefits of scientific investments in HIV have been profound. They accelerated  COVID-19 and malaria vaccines development and even personalised cancer therapy. 

Human rights values underpinned HIV struggle

Delegates at the 2022 International AIDS Conference calling for the end to criminalisation of key populations most vulnerable to HIV/AIDS.

But even more, the values underpinning the HIV struggle transformed society. People with HIV refused to be victimised and taught marginalised communities such as LGTBQ+ to stand up for their rights and win basic legal entitlements in many places. Religious orthodoxies performed theological gymnastics to sanction condom use thereby benefitting the reduction of other sexually-transmitted infections and contributing towards cervical cancer prevention.  

HIV education strategies countering stigma enabled people with TB  and the mentally ill to come out of the shadows.  The skills to manage AIDS  brought compassion and courage to overcome the fear of contagious conditions such as Ebola.   

 The human rights gains triggered by HIV/AIDS established the primacy of inclusion in public policy such as for refugees and migrants. Of course, such rights are not universally realised and often threatened. But HIV showed the worth of struggling and how to do it.

HIV  widened public health ambitions, and birthed health diplomacy to create the modern global health movement. The bold demand for antiretrovirals for all with HIV disease was a precursor of the COVID-19 slogan, “no one is safe until all are safe”.  The universalist vision of HIV treatment negotiated far-reaching flexibilities in the Trade-Related Intellectual Property Rights (TRIPS) regimen allowing treatment costs to drop by a staggering 99 per cent.  This got the generic medicines genie out of its over-priced bottle.

The HIV emergency is an inspiring battle against today’s emergency around non-communicable diseases (NCDs) – diabetes, cancers,  cardiovascular and respiratory conditions – that cause  74% of global deaths. And so NCD treatment costs have tumbled including insulin.

New paradigm of accessibility

Thus, HIV gave rise to a new paradigm of availability, accessibility, and affordability  for all essential drugs and diagnostics. That makes feasible, Universal Health Coverage (UHC), the core of  Sustainable Development Goal 3.  HIV has shown what is doable against the odds, given the vision, will, partnerships, and resources. 

It is the last aspect – resources – that raises new questions, considering HIV’s trajectory.  There were 39 million people living with HIV in 2022 giving a global median prevalence of 0.7 per cent among adults  aged 15-49 years. In the same year, 1.3 million were newly infected (reduced by 59% since the 1995 peak) and 630,000 died (reduced by 69% from its 2004 peak).

A 2021 UN General Assembly  Political Declaration called for ending AIDS  by 2030 through sufficient HIV reduction to remove it as a population threat. The associated strategy centres on prevention through testing and treatment, a creative approach that could also work with some other conditions. 

The key targets are that 95% of people living with HIV should know their HIV status, 95% of the latter should be on antiretroviral treatment, and 95%  of treated people should be virally suppressed, and therefore unable to transmit infection to others.  

By 2022, 89% of people who were aware that they had HIV were on antiretroviral treatment.

There is impressive progress. By last year, 86%  of people living with HIV knew their status, 89%  of HIV-aware people were accessing treatment of which 93% were virally suppressed. 

The 2030 targets should be achievable with several countries already reaching or exceeding the 95/95/95  benchmarks.  From being a global pandemic,  HIV has been geographically contained. Africa still accounts for most (38 per cent)  of new infections with HIV’s gender dimension most evident in sub-Saharan African women who bear the brunt.

The global decline is bucked by parts of Eastern Europe and Central Asia, Middle East and North Africa, and Latin America showing rising incidence. Nevertheless, HIV is increasingly concentrated in key populations such as gay and transgender persons, and in vulnerable settings such as sex work, injecting drug use, and prisons.  Certainly, there is more to do especially with authorities whose retrogressive and prejudiced policies fuel virus spread.  That reinforces the case for targetted, not generalised, approaches. 

It necessitates decentralised, focused spending by re-orienting global flows towards low- and middle-income countries. They currently spend $20-22 billion annually on HIV, of which around 60%  comes from their own budgets. External aid from PEPFAR, Global Fund, and others provide the rest.

UNAIDS projects a $29.3 billion global investment requirement in poorer countries in 2025. Meanwhile, as a sign of success, more and more people live long healthy lives on permanent HIV treatment. The sustainable financing of an increasingly endemic condition needs figuring. 

The last mile is always the most expensive to traverse. Especially at a time when the going is harder due to many conflicts and climate change disasters that increase population displacement and vulnerability.  But more HIV funding will not defuse underlying causes while making a marginal difference to mitigating the symptoms.

Should UNAIDS close by 2030?

UNAIDS Executive Director Winnie Byanyima addressing the UN.

With HIV already out of the list of top 10 killers by 2019, how cost-effective is our array of HIV-focused bodies?  It implies getting HIV out of the current vertical campaign mode and integrating it into UHC systems.  Why wait till 2030 to make the transition?

There is a reluctance to move faster because such change poses an existential threat to HIV-centered institutions. Do we still need UNAIDS and its $210 million annual budget? Can we justify the individual HIV units and separate programme spends of the 11 co-sponsoring agencies of UNAIDS? Can we continue to spend $15.7 billion bi-annually on just three diseases – HIV, TB, and malaria, as the Global Fund does? Not to forget the billions on HIV via the World Bank and bilateral donors, including PEPFAR’s $6.9 billion in 2023. 

A fundamental re-ordering is needed. Perhaps downsized UNAIDS staff could return to their original home at WHO which should continue its normative guidance and country support technical roles.  Thanks to the aid localisation movement and the maturing of civil society over the past decades, there are plenty of groups on the ground to keep running with the psychosocial and human rights aspects of the HIV struggle.

And the Global Fund, while continuing to finance HIV, TB, and malaria, should extend value-for-money by taking on additional challenges worthy of its clout (say dementia and cancer).

There are many examples of organisations adjusting their work in the face of altered requirements. But never has a UN agency closed shop voluntarily. UNAIDS, at its start, pioneered  UN reform. It could trail blaze again by closing its doors, say in 2030. 

A  commemorative monument could be erected at its spacious Geneva headquarters. The new occupants – putting their great minds to tougher tasks – will be inspired by walking past the exhibition in the foyer on one of our greatest public health triumphs. 

Perhaps they will pause for reflection at the display containing the medal of  the Nobel Prize for Medicine – a fitting way to bid farewell to UNAIDS, the only world agency with the foresight to do itself out of business.  

Mukesh Kapila, Health Policy Watch editor-at-large, is a physician and public health specialist who has held senior positions at the World Health Organization, United Nations, and as Under-Secretary-General at the International Federation of Red Cross and Red Crescent Societies. He began his public health career as the Head of Conflict  & Humanitarian Affairs for the UK’s Foreign Office.  

This is the first of a series of periodic “stocktake” papers reflecting on progress made and constraints faced on the journey to achieving the Sustainable Development Health Goal, SDG 3.

 

Image Credits: Louis George 2011 , Cecille Joan Avila / Partners In Health, Marcus Rose/ IAS, Flickr.

RANA executive director Aggrey Aluso and Pandemic Action Network executive director Eloise Todd.

LUSAKA, Zambia — A new African civil society network to address pandemics and climate crises was introduced publicly on Wednesday on the sidelines of the Conference on Public Health in Africa (CPHIA). The Resilience Action Network Africa (RANA) has been established by over 30 African organizations that are part of the global Pandemic Action Network (PAN), which was formed during COVID-19.

“This journey started a long time ago,” RANA executive director Aggrey Aluso told Health Policy Watch. “The voices of the global South and the concerns of low- and middle-income countries, particularly in Africa, do not inform global policies. But ‘the people who wear the shoe know where it pinches most.’”

The resilience agenda has come to characterise Africa’s challenges, including surging climate change challenges, disease outbreaks, gender inequality, food insecurity, and financial instability, Aluso explained.

“If we continue to address these challenges in isolated silos, we will not be strong enough,” Aluso said.

At the heart of RANA’s strategy to dismantle these silos is a collaboration with the Pandemic Action Network (PAN). Leveraging PAN’s proven track record in networked advocacy for pandemic prevention, preparedness, and response, the partnership will adopt a “whole-of-society” approach to bridging policy gaps at the national and regional levels in Africa, while empowering local institutions and agencies to bolster health systems.

RANA’s partnership with PAN seeks to establish connections between pandemic issues and advocates and networks across the resilience agenda, encompassing gender, climate, finance, food systems, health, and nature. RANA’s affiliates are primarily engaged in pandemic and climate threats, gender and debt.

RANA is more than 30 civil society partners (CSO) strong, and growing — including those representing the gender, climate, finance, food systems, health, and nature agendas.

“The idea is that PAN and RANA will work really closely in the pandemic prevention, preparedness and response, and climate and health crisis space,” PAN executive director Eloise Todd told Health Policy Watch. “We will basically work in lock-step to ensure that community voices and African countries are presented in global processes.” 

“If you think about the INB [Intergovernmental Negotiating Body] negotiating the pandemic treaty, for example, we want to make sure that we insert the voices of the low and middle-income countries,” said Todd. “We want to do that more deliberately and invest more to have this separate, independent entity and really walk the walk and take our lead from an independent, partnered organisation.”

One of RANA’s first campaigns is to advocate for African leaders to commit to an agenda for pandemic action. This includes calling on African countries to allocate long-term domestic financing to “close critical pandemic prevention, preparedness, and response funding gaps in Africa”; to expand the local production of health products including diagnostics, medicines and vaccines; and to make African health systems gender-responsive, and pandemic and climate-resilient.

These demands are part of the Africa Centres for Disease Control and Prevention’s (Africa CDC) Africa’s New Public Health Order, a long-term vision for a more resilient, inclusive, and equitable African public health system.

“Humanity is facing two major existential threats: climate change and pandemics. These global threats are highly interconnected, and their risk to lives, livelihoods, human progress, and human rights is growing,” said Todd. “We must shift our policy thinking and our investments to strengthen the resilience of our countries, our communities, and our people.”

Aluso, who will continue to serve as PAN’s Africa Director and Global Policy Lead, said that the multiple crises “require bold thinking, bold collaboration, and bold action”.

“Our vision is a resilient and healthy Africa, safeguarded by African-led solutions, informed by African needs, and driven by African leadership,” he said.

24th International AIDS Conference, Montreal, Canada.

As donors withdraw from HIV, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has chosen to focus on the importance of community-led interventions to end the AIDS pandemic for World AIDS Day on 1 December.

“There has been an unprecedented backsliding in financial commitments to community-led organisations, and it is costing lives,” according to UNAIDS Executive Director Winnie Byanyima, writing in her organisation’s annual World AIDS Day Report released on Tuesday.

“Crackdowns on civil society and on the human rights of people from marginalised communities are obstructing the progress of HIV prevention and treatment services, putting the fight against AIDS at risk,” she added.

“Harmful laws and policies towards people from populations at risk of HIV threaten the lives of community activists trying to reach them with HIV services. Too often, decision-makers treat communities as problems to be managed, rather than as leaders to be recognised and supported.”

The report is “an urgent call to action for governments and international partners to enable and support communities in their leadership roles”, according to UNAIDS.

People living with and affected by HIV have been particularly influential in the HIV response, according to the report.

“They are the trusted voices. Communities understand what is most needed, what works, and what needs to change.”

A United Nations high-level meeting on AIDS in 2021 adopted a political declaration that contains various commitments to recognise community initiatives. These include that, by 2025, community-led organisations should deliver 30% of testing and treatment services, 80% of HIV prevention services for people from populations at high risk of infection, and 60% of programmes to support societal changes that enable an effective and sustainable HIV response. 

In addition, they agreed on the 10–10–10 targets to remove punitive laws against LGBTQI people, people who use drugs, sex workers and people from other often criminalised populations, and to reduce stigma and discrimination, gender inequality and violence experienced by people living with HIV and people from key populations and priority populations

The report includes nine guest essays by community leaders that show how they have been able to drive change, how they experience obstacles in their way, and the actions they are urging governments and international partners to take to enable communities to lead us to the end of AIDS by 2030.

Image Credits: Marcus Rose/ IAS.