COP28, the 28th Conference of the Parties to the United Nations Framework Convention on Climate Change (UNFCCC), will take place from November 30 to December 12, 2023, at the Expo City complex in Dubai, United Arab Emirates.

Negotiators at the upcoming UN Climate Change Conference (COP28) must accelerate the end of fossil fuels, eliminate trillions in fossil fuel subsidies, and swiftly transition to clean, renewable energy to reap the health benefits of climate action, senior World Health Organization (WHO) officials urged at a press briefing on Tuesday.

Despite the absence of explicit mention of fossil fuels in the draft “Health Declaration” to be signed by UN member states at the climate conference, which begins on Thursday, negotiators working on the outcome document must recognise that “we need to halt emissions and accelerate the transition to clean, renewable energy for the sake of health,” stated Dr. Maria Neira, director of WHO’s Department of Climate, Environment, and Health.

“The more we postpone action on reducing emissions and accelerating this transition to clean, renewable sources of energy, the more we rely on fossil fuels, the more our health will be paying the price that is very high,” Neira said. 

‘Healthwashing’ or real progress? 

While this year’s COP is poised to host the first-ever ministerial level “Health Day”, with a strong commitment from the COP Presidency and UAE hosts to highlight the issue, civil society groups have expressed concerns that these moves could amount to a “greenwash” of a conference hosted by a petrostate, where oil and gas lobbyists will have a prominent presence.

Meanwhile, other sources have informed Health Policy Watch that the decision to set aside ‘fossil fuels’ language in the health declaration was made deliberately to ensure that the issue is thoroughly addressed in the core negotiations by member states rather than being relegated to a single thematic area, regardless of health’s importance.

Exclusive: COP28 Climate and Health Draft Declaration Ignores Fossil Fuels as Driver of Health Harms 

Addressing the briefing, WHO officials were adamant that they are carrying an unequivocal message on the issue to COP negotiators. 

“What we are telling the negotiators is the more you postpone action, the more you are taking responsibility for not addressing the health consequences,” said Neira.

Dr Diarmid Campbell-Lendrum, who leads the climate change and health unit at WHO, added that achieving the 2015 Paris Agreement’s climate goals sooner rather than later would also save approximately 1 million lives annually by reducing air pollution-related mortality. Conversely, delaying action will result in more avoidable deaths from warming and an increase in air pollution-related deaths.

“We believe that the health argument supports the case for rapid action because there is a significant difference between waiting until 2029 to attempt a rapid reduction in admissions and waiting until 2049 to do the same,” Campbell-Lendrum explained.

“For one thing, you’ve left a lot of carbon in the atmosphere by not starting earlier, accumulating much more carbon in the process. Additionally, you’ve missed the opportunity to save a lot of lives if you leave it until the last minute to intervene. The economics of this are clear,” he stated.

Dr Diarmid Campbell-Lendrum, head of the WHO’s Climate and Health team

“The health argument is also clear on this – the sooner we act, and the more ambitiously we act, the more affordable it is to address the climate crisis but also to save more lives,” Campbell-Lendrum said.

Campbell-Lendrum acknowledged that the financial cost of climate policies is often raised as the main counterargument to action. “it costs money,” he said.

However, he countered that this argument is not valid given the trillions currently allocated to fossil fuel subsidies. Taxpayers worldwide shouldered an additional cost of approximately $600 per household last year to subsidize fossil fuel consumption, Campbell-Lendrum said.

When factoring in the health detriments caused by fossil fuel consumption, the IMF estimates that the true subsidy is closer to $3,500 per household globally.

“The money is there. We’re just not spending it in the right place,” he said. “Part of the message we’re taking to COP is we need to invest in a healthier, greener future for everybody.”

What to expect at COP28

Along with a full-fledged Health Day on December 3, attended by some 65 ministers of health, dozens of health-related events are planned to unfold throughout the two weeks of the climate conference.

At the WHO’s COP28 Pavilion, some 40 thematic events are planned on topics such as climate change and health, while other health-related climate events will be staged in the pavilions of the Climate and Clean Air Coalition, the SDGs, the World Bank, and even the pavilion of the Cryosphere.

An innovative model health clinic powered by renewable energy will also be on display at the COP, showcasing the potential for health facilities to operate sustainably and contribute to climate change mitigation.

“We will be demonstrating that even healthcare facilities that are currently not contributing to a carbon footprint can access clean energy without exacerbating climate change,” said Dr Maria Neira, Director of WHO’s Department of Climate, Environment, and Health.

Approximately one billion people worldwide are served by health facilities that lack access to adequate and reliable electricity for essential health services, including emergency care, disease control, and childbirth according to a WHO report published earlier this year.. Over 430 million people are served by primary care facilities that have no electricity at all.

On the other end of the spectrum, healthcare services in middle- and high-income countries are among the largest energy consumers of any economic sector, accounting for about 5% of global carbon emissions.

WHO’s alliance on transformative action on climate and health (ATACH)

Dr Maria Neira, WHO Director of Climate, Environment and Health, lays out plans for health events at COP28.

WHO also has established a new platform, called the Alliance on Transformative Action on Climate and Health (ATACH). Through ATACH, member states can make voluntary declarations on plans to make health facilities more climate-resilient and sustainable, and they can also access technical support, quality assurance, and financing for decarbonizing health systems.

To date, 78 countries have joined the Alliance, with 71 committing to become “sustainable, low-carbon” health systems and 29 pledging to reach net zero in the health sector by 2030, 2040, or 2050.

“We, as the health sector, can reduce our own carbon footprint by decarbonizing our interventions that at the moment contribute to 5% of the global emissions,” Neira said.

Image Credits: Dennis Sylvester Hurd.

CPHIA co-chair Professor Margaret Gyapong, Africa CDC Director General Dr Jean Kaseya and Zambian Health Minister Sylvia Maseko address the media shortly before the conference opening.

LUSAKA, Zambia – Ensuring that Africa can manufacture its own vaccines will represent “the second independence of Africa”, Dr Jean Kaseya, Director General of the Africa Centre for Disease Control and Prevention (Africa CDC), said at the start of the Conference for Public Health in Africa 2023 (CPHIA) on Monday.

“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 shortly before CPHIA’s opening. “Other continents locked their doors and we were left beyond.” 

With over 5,000 in-person delegates and an additional 20,000 virtual participants in attendance, Kaseya described CPHIA23 as the largest global public health event outside the annual World Health Assembly.

Stung by Africa’s inability to access COVID-19 vaccines during the pandemic’s peak as wealthy countries hoarded supplies, African heads of state have committed the continent to manufacture 60% of the vaccines it needs by 2040. 

This is a mammoth task considering Africa currently produces only 1% of its vaccines. Although many believe this impossible to achieve, Kaseya said he would not be in his current position if he did not believe it was possible.

The Partnerships for African Vaccine Manufacturing (PAVM) is driving this ambition, which recently received a huge shot in the arm from the global vaccines platform, Gavi, according to Kaseya.

Gavi’s policy committee has approved a $1 billion investment in a partnership with the Africa CDC to support the development of African vaccine manufacturers. This decision will be discussed by the body’s board in December, Kaseya added.

The Mastercard Foundation is also playing a major role in supporting Africa CDC and African countries to build their capacity to vaccinate their populations.

The Mastercard-sponsored ‘Saving Lives and Livelihoods initiative’ is focused on vaccinating high-risk populations, integrating the COVID-19 response into routine immunisation and preparing for potential future pandemics.

Full house at the opening of CPHIA2023

One more step to ‘decolonise’ research

However, Dr John-Arne Røttingen, Norway’s Ambassador for Global Health and Wellcome Trust CEO designate, said that improving manufacturing “isn’t enough” as Africa needs to build an entire “biomedical system”.

Addressing the opening plenary, Røttingen said that global health had come a long way since the era of colonial researchers but that this process of “decolonisation” needed one more step – “African health research systems led by Africans”.

“It is not just about the undoing but the doing,” urged Røttingen.

Also addressing the plenary, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyusus said that he was elected as the first African head of the global body because the continent stood together to support one nomination.

Subsequently, this unity had enabled Africans to be elected to head the World Trade Organization, UNAIDS, the International Labour Organisation and other UN bodies, he added.

“It is very important for Africa to continue to be united,” Tedros urged.

Meanwhile, Kaseya said that the Africa CDC had built “health diplomacy” between African countries.

“Even if you are fighting politically, even if you are fighting military a disease outbreak will cross the border without your permission. This is why Africa CDC has a global diplomacy department to facilitate dialogue between countries between communities and to ensure that all of them have access to support to commodities when they need them.”

African-led health initiatives

Zambia’s Minister of Health, Sylvia Maseko, said that the purpose of the conference is “to reposition Africa in the global health architecture”.

“Some of the key achievements that we have made so far include approval and launch of the Africa CDC strategic plan 2023 to 2027, which outlines a clear roadmap to address the continent’s health challenges, strengthen public health systems, and ensure a coordinated response to emerging threats,” said Maseko.

“Secondly, we have done the formation and inauguration of the new Africa CDC advisory and technical Council and we have inaugurated the new governing board of the Africa CDC, which saw me as the new chairperson,” said Maseko. 

Meanwhile, CPHIA co-chair Professor Margaret Gyapong said that the continent had made major scientific advances in the last few years, including in digital disease surveillance, and building public-private partnerships.

“African scientists and researchers are leading the charge in developing groundbreaking vaccines tailored to address regional disease burdens, including malaria, tuberculosis and HIV and AIDS,” said Gyapong, who directs the Institute of Health Research at the University of Health and Allied Sciences in Ghana.

“Groundbreaking initiatives such as the RTS,S malaria vaccine demonstrates the significant contribution of African scientists and researchers in collaboration with national centres and organising for address regional disease burdens.”

Gavi’s interim CEO, David Marlow, said that the vaccine platform had set up the African Vaccine Manufacturing Accelerator to assist with the development of manufacturing capacity on the continent “and it would be ideal if malaria was a priority antigen”.

Professor Margaret Gyapong, Africa CDC Director General Dr Jean Kaseya and Zambian Health Minister Sylvia Maseko

Massive debt repayment challenges

Despite the upbeat tone of the speakers, some of the challenges facing the continent were also acknowledged. Only 28% of health facilities have electricity, for example, 70% of maternal deaths happen in Africa and the continent has a significant shortage of skilled healthcare workers.

In addition, COVID-19 has decimated the already weak economies of many of the 55 African member states and many simply don’t have money to invest in their health systems. 

In 2021, CPHIA host country Zambia was the first to default on its debt repayments as a result of COVID, although last month announced that it has restructured $3 billion of its international bonds with creditors. Mali briefly defaulted by has resumed payments, but Ghana has also stopped servicing its debt. 

Chad, Ethiopia, and Malawi have opted to restructure their debt. However, in the process of doing so, Malawi devalued its currency by 44% earlier this month and this is likely to drive citizens in one of the world’s poorest countries further into poverty.

Climate change is also a major threat to the continent, with the African Development Bank estimating that it is losing between 5-15% of its GDP due to climate change.

“Do you know that we have 18 countries today affected by cholera, and that is the effect of climate change with 4,000 deaths? Do you know that dengue in West Africa is also the effect of climate change?” Kaseya asked the media briefing.

“You saw the flooding in Libya. Climate change is affecting us. And this is why Africa CDC decided to implement a One Health approach to address the issue of climate change, animal health and human health.”

Aerial view of Accra, Ghana. Traffic, waste burning and desert dust all combine to make pollution a problem in this fast-growing city.

Africa is home to many of the world’s fastest-growing urban centres – and a crisis of air pollution faces the continent’s rapidly expanding cities, according to a new Clean Air Fund report released Thursday. 

Africa, home to the world’s youngest population, is expected to see its population nearly double by mid-century, reaching 3.9 billion by 2100. 

Over 65% of Africa’s population will reside in urban areas by 2060, with the continent potentially hosting five of the world’s ten largest megacities by the end of the century, according to the report. The 600-mile coastline stretching from the Nigerian capital of Lagos to Abidjan in Cote d’Ivoire alone is projected to be home to around half a billion people by 2100. 

Africa’s rapid urbanization is providing an engine for its fast-growing economies, but there is a significant hidden cost: air pollution.

“The challenges that flow from rapid urbanization across the continent are immense, including drastic increases in air pollution and greenhouse gas emissions, which if unchecked will bring disastrous consequences for human and economic health,” Kevin Urama, Chief Economist at the African Development Bank, explained in a statement accompanying the report’s launch. 

Across the six cities, potential reductions in greenhouse gas emissions vary, with some achieving a reduction of up to 35%, resulting in a collective avoidance of 0.8 Gt CO2e. (BAU = business as usual)

The study focuses on six major and rapidly expanding African cities—Accra, Cairo, Johannesburg, Lagos, Nairobi, and Yaoundé. Air pollution led to over 56,400 premature deaths across the six cities in 2022, costing a minimum of $2 billion, the report found. Toxic air claimed an estimated 1.1 million lives across Africa in 2019—surpassing the combined toll of tobacco, alcohol, motor vehicle accidents, and unsafe water. 

Road traffic is identified as the largest contributor to PM2.5 air pollution concentrations across the six cities studied, accounting for 30% and 40% of PM2.5 concentrations in Lagos and Accra, respectively.

Other culprits include industrial activities, power plants, biomass fuels, and waste mismanagement. As the cities grow and their populations rise, emissions from these sources are set to skyrocket. More people will require more cars, energy, and fuels, and create more waste, leading to a spike in air pollution. 

If current trends persist, the financial toll of air pollution in Africa’s major cities could surge more than eightfold by 2040, the report found. The cost will also be paid in over one million premature deaths by 2040 – 109,000 of which can be saved by implementing policies to combat air pollution. 

“On the current trajectory, following a ‘business as usual’ approach means air pollution will collectively cost Accra, Cairo, Johannesburg, Lagos, Nairobi, and Yaoundé an estimated $138 billion in premature deaths and worker absenteeism over the next two decades,” said Urama.

Opportunities to change track 

Implementing policies to reduce air pollution could prevent a total of 109,000 premature deaths across the six cities between 2023 – 2040, according to the report.

Despite the grim outlook, the report presents a roadmap to avert the potentially catastrophic consequences of air pollution . It emphasizes the potential for substantial economic benefits—billions of dollars saved, reduced deaths, improved public health, lower emissions, and decreased poverty—of implementing policies promoting green growth.

The report urges African governments to review high-emitting sectors at the national level, including energy, transport, industry, power production, agriculture, and waste management.

By identifying ways to reduce air pollution in these sectors, governments can simultaneously address climate change, and create opportunities for green economic growth. The report emphasizes the need to enshrine air quality targets into national and district-level laws, ensuring long-term commitment beyond political cycles.

City mayors and local government leaders are urged to adopt low-cost, low-maintenance air quality monitoring devices to gather comprehensive data for evidence-based decision-making. These devices will enable cities to pinpoint pollution hotspots, track trends, and assess the effectiveness of mitigation strategies.

As more governments and municipalities embrace air monitoring technologies, data sharing can also be enhanced across borders and within countries, empowering local and national authorities to formulate evidence-based policies on air quality-related public health matters.

Accra could unlock $25m, Johannesburg $55m, Nairobi $23m and Yaoundé $27m in 2040 alone by implementing clean air measures.

Across Accra, Cairo, Johannesburg, Lagos, Nairobi, and Yaoundé, implementing clean air measures such as upgrading public transport and adopting cleaner cookstoves could save over $19.2 billion across the six cities by 2040.

In Accra, which will host the first-ever World Health Organization (WHO) air pollution summit in 2024, the economic impact of air pollution, including absenteeism and premature mortality, is expected to quadruple between 2019 and 2040. However, the city could unlock over $25 million in 2040 alone through implementing measures to reduce air pollution.

While the report’s financial projections are significant, it acknowledges that the true benefits could be even greater, considering the positive ripple effects on healthcare, agriculture, productivity, and the environment.

“The projected benefits from air quality action are expressed in this study in financial terms, but these financialised benefits should not be understood to mean tangible funds raised or costs saved,” the report notes. “The co-benefits gained from air quality action provide greater cost-effectiveness that recycles into local economies, strengthening health systems, businesses and government finances.”

By implementing clean air measures, such as upgrading public transport and cleaner cookstoves, these six cities could save over $19.2 billion between 2023 – 2040.

The report also highlights the startling lack of international and multilateral development funding to fight air pollution in Africa, with only 5% of total aid directed at reducing air pollution on the continent.

In Lagos, a city home to nearly 16 million people, the official development funding directed toward air pollution from 2015 to 2020 amounted to a mere $0.25 million. Air pollution claimed 70,000 in the city in 2019 alone. 

Between 2015 and 2021, donor governments provided a stunning 36 times more aid for prolonging fossil fuel use in Africa than tackling air pollution, despite the continent facing temperatures warming faster than the global average.

The report calls on international and multilateral development banks to provide increased technical support to assist countries in accessing green funds, dedicated funds for financing air quality data monitoring capacities are recommended, acknowledging the critical role such data plays in obtaining other climate financing.

“It is well understood that tackling poverty, bringing clean water to people everywhere, and investing in education are all critical to Africa’s development,” said Urama. “Ensuring our citizens can breathe clean air is also a vital, but too often neglected, piece of this puzzle.”

Image Credits: WHO/Blink Media, Nana Kofi Acquah.

Dr Margaret Chan former director of the World Health Organization, in a University of Geneva panel session with public health students Youjia Liu and Tingkai Zhang,

On her first visit back to Geneva since leaving her post as WHO Director-General in 2017, Dr Margaret Chan urged public health students to recognize “the power of collaboration” and to  “use their voice” to hold policymakers accountable for the changes that the promises that they make. 

“When I was in WHO, there were a lot of negotiations, a lot of resolutions.  But do you think countries kept their promises?” she asked. “We are waiting for the day when leaders of countries walk their talk. But you have a voice. Use your voice in a system that you know well, to advocate.” 

Chan, now Dean of the Vanke School of Public Health in China, was speaking at last week’s event “One Planet One Health”  co-sponsored by the University of Geneva and the Geneva Health Forum.  

The event brought together Chinese students from Vanke with counterparts from the University of Geneva’s Institute of Global Health – as part of an academic collaboration forged between the two institutions after Vanke opened its doors under Chan’s leadership in 2020.   

Geneva at the heart of ‘One Health’ efforts 

In a presentation preceding her panel discussion with three Geneva and China-based students, Chan declared that Geneva, home of the WHO, the World Meteorological Organization and countless other civil society and research institutions, needs to also be the heart of One Health efforts. 

Those efforts bring together action on climate change with action on new disease threats that are emerging at an evermore rapid pace, with changes in climate, deforestation and the loss of biodiversity, she said.  

“One cherished memory I have of my time in Geneva was the sight of my friends heading to ski,” she recalls, of her 15 years living in Switzerland, beginning with her first WHO appointment in 2003 as the director of the Department of Public Health and Environment.  

“Their faces were aglow with excitement as the world around them was painted in a pristine blanket of white. 

“Yet this year paints a different picture,” she said, referring to the weeks of rain that the city has seen this November. “The familiar white landscape … and the thrill of skiing is replaced by a visible absence of snow. 

“This … my friends, is climate change, reshaping the city and the world we all love. This is a reflection of a broader global shift -from the dwindling expenses of the Amazon rainforest and the melting Siberian permafrost to the receding snow cover of the Tibetan plateau and the vanishing ice sheets in West Antarctica. And these aren’t isolated incidents. They are interconnected sides of our earth’s transformation.

“As of 2023, we have surpassed nine out of the 14 tipping points of our earth’s system, changes that are irreversible and leading to abrupt shifts in our environment. 

“Climate change, as I have said many times, is a defining issue of the 21st century. Climate variables affect the air we all breathe, the water we drink, the food we eat and even where we are able to live.  Extreme weather events are becoming the norm and records are constantly being broken, she said ravages of the past summer in the northern hemisphere. 

“Beijing, the city I know better, suffered record-breaking heat waves. Then, Beijing again was inundated by the heaviest rainfall in 140 years. Another example. Hawaii. It is known for its beauty.  Now it is scarred by wildfires that ravaged Maui. Florida’s ocean temperature reaches a staggering 38 °C. And right here in Geneva, the World Meteorological Organization delivers sobering news of the hottest June ever recorded. 

“As UN Secretary-General Antonio Guterres commented, ‘The era of global warming has ended. The era of global boiling has arrived’.”

Nature never deceives us

From left to right: Dr. Ilona Kickbusch, moderator, with students Kailing Marcus, Youjia Liu, Tingkai Zhang, and former WHO Director General, Dr Margaret Chan.

“Grand challenges require grand actions,” Chan added. “In the historic 2015 Paris Agreement on climate change, countries made important commitments to cut greenhouse gas emissions and scale up adaptation, adaptation to climate change. 

“The Paris Agreement is not just a treaty for saving the planet from severe and irreversible damages. It is also a significant public health treaty with a huge potential to save lives worldwide,” added Chan, speaking just two weeks before the UN Climate Conference COP 28 in Dubai launches the third global “stocktake” of progress made, eight years on.  

And despite the critical importance of a more rapid fossil fuel phase-out, “the energy transition, switching from fossil fuels to renewable renewable energy are just a part of the solution,” Chan pointed out. 

Interconnected web

The other side of the climate coin is a ‘One Health’ approach recognizing that “humans along with the animals and plants around us, and the environment that nurtures us, are all part of a single interconnected web, Chan said. 

Even before arriving in Geneva, Chan had considerable experience with the threats that nature can unleash on human health.  As the Director of Public Health in Hong Kong, she had to meet the challenges there of the first H5N1 (Avian flu) outbreak in 1997, followed by the SARS outbreak in 2003.  

Arriving at WHO in 2003, she oversaw some of the agency’s early initiatives on climate, health and biodiversity as head of the Department of Public Health and Environment. Later, as Director-General, she was faced with the unprecedented challenge of the West African Ebola outbreak between 2014 and 2016, one of the most deadly seen on the continent in modern times. 

Recognizing the intricate relationship between animal-borne pathogens and human infections, she helped advance the early phases of the  “Tripartite” Collaboration on One Health involving  WHO, the Food and Agriculture Organization and the World Organization for Animal Health. 

“The majority of new pathogens are caused by diseases of animals that spread to humans, such as flu, rabies, SARS and COVID 19,” said Chan in her lecture. “This is especially an issue in the context of climate change.  Why?  Because climate change is a threat multiplier.  Existing threats can be spread to a new geographically area.  

“For instance, the emergence of Nipah virus and Hantavirus as human pathogens has been traced to extreme weather events that forced more animal hosts to leave their ecological niches and invade human settlements.

“In the past 30 years. of the new human pathogens identified, and an astonishing 75% can be traced back to animals,” she said.

“The message is loud and clear. We need to adopt the One Health approach recognizing and respecting a symbiotic relationship between humans, animals and our shared environment. 

“The one health approach is an integrated approach to tackle global health threats,” Chan declared. “Prevent, predict, and respond. It is high time we adopt a holistic perspective.”

Along with climate action and action to preserve the integrity of the natural world that is the fundamental basis for human life, equity is yet one more dimension to the One Health approach, said Chan. 

“We often delve into the deep interconnections between humans, animals and the ecosystem. Yet, at the core of this idea, lies another profound truth – the essence of not distinguishing one human from another,” she said. 

“Regardless of our diverse backgrounds, culture and beliefs, we are all Homo sapiens. It is high time we adopt a holistic perspective, looking at humanity as one cohesive unit right here in the heart of Geneva.

Dr Margaret Chan

From dean to student  

In a subsequent panel discussion, Chan and three students from Tsinghua University exchanged views on how they, as young people, could act on the challenges in public health, their own professional path and facing their generation. 

Youjia Liu, a student at Tsinghua University, described her experience last summer carrying out public health research in the remote mountain villages of Cambodia, which sensitized her to the difficulties of people accessing regular health care at a time when there is also a lot of migration along the border and changing patterns of malaria.

“We always talk about this access to health care,” she said. “And it seems like something that only local governments can really work on. But what can we do? This is related to the topic, One Climate, One Health. People live in remote areas and are actually very vulnerable groups.”

“I don’t really have a good answer for you,” said Chan, noting that the lack of healthcare workers in ‘last mile’ regions of the world is a longstanding problem happening in many countries of the world. 

“But you mentioned the local government. These people need to speak out. And your duty is to teach them to speak up. Okay? Don’t take things for granted. And of course, that is easier said than done. This is the reality we live in. 

Citing the collaboration between the two universities as an example of cross-cultural collaborations, Chan urged students to “take the lead to address these global challenges.

“In English, Tsinghua’s University’s motto translates into ‘self discipline and social commitment’,” Chan stated. 

“Young people in universities are privileged, and it is their duty to confront these challenges. The path may be arduous, but with determination and unity, there is no summit we cannot reach. 

“I urge you, don’t give up hope.  Can you imagine? I was Director-General in the era of the MDGs [Millennium Development Goals] remember? The world is a better world now compared to the time when we were dealing with MDGs. So continue to make the effort. Don’t give up.”

Shoppers wear masks in Guangzhou, China.

Unusual outbreaks of respiratory illness and pneumonia in Chinese children have prompted the World Health Organization (WHO) to ask the country for detailed information. 

Children’s hospitals in Beijing and Liaoning Province, some 800km apart, are “overwhelmed with sick children, and schools and classes were on the verge of suspension”,  according to local Chinese media, as reported by ProMed International Society for Infectious Diseases.

Beijing Children’s Hospital was overcrowded with parents and children with pneumonia, according to ProMed.

 “Many, many are hospitalized. They don’t cough and have no symptoms. They just have a high temperature (fever) and many develop pulmonary nodules,” according to a resident quoted in the report.

The lobby of Dalian Children’s Hospital in Liaoning Province is full of sick children receiving intravenous drips, according to ProMed.

Meanwhile, local authorities in Shandong Province in north-eastern China have advised people to wear masks and get influenza vaccinations, according to Nikkei Asia.

At a press conference on 13 November 2023, the Chinese National Health Commission reported an increase in the incidence of respiratory diseases in China at a media briefing on 13 November, according to the WHO.

They attributed this to “the lifting of COVID-19 restrictions and the circulation of known pathogens such as influenza, mycoplasma pneumoniae (a common bacterial infection which typically affects younger children), respiratory syncytial virus (RSV), and SARS-CoV-2 (the virus that causes COVID-19)”.

On Wednesday, the WHO “requested additional epidemiologic and clinical information, as well as laboratory results from these reported clusters among children, through the International Health Regulations mechanism”, said the WHO in a statement.  

Influenza-like

“We have also requested further information about recent trends in the circulation of known pathogens including influenza, SARS-CoV-2, RSV and mycoplasma pneumoniae, and the current burden on health care systems. WHO is also in contact with clinicians and scientists through our existing technical partnerships and networks in China.”

The WHO also notes that since October, northern China has reported an increase in influenza-like illness compared to the same period in the previous three years. 

“While WHO seeks this additional information, we recommend that people in China follow measures to reduce the risk of respiratory illness, which include recommended vaccination; keeping distance from people who are ill; staying home when ill; getting tested and medical care as needed; wearing masks as appropriate; ensuring good ventilation; and regular hand-washing,” said the WHO.

The first cases of COVID-19 were detected in Wuhan in central China in December 2019, and by March 2020, the WHO declared a pandemic. That was caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which originated in bats.

Image Credits: China News Service／中国新闻网, Flickr: ZhiZhou Deng.

One-third of people in 14 countries in the Western Balkans, the Caucasus and Central Asia used antibiotics without a medical prescription, according to a survey released on Wednesday by the World Health Organization’s (WHO) European Region.

The survey involved 8221 participants, half of whom reported taking oral antibiotics in the past 12 months. 

Participants came from Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Montenegro, North Macedonia, Moldova, Tajikistan, Türkiye and Uzbekistan. 

The most common reasons cited for taking the antibiotics were colds (24%), flu-like symptoms (16%), sore throat (21%) and cough (18%). These are often caused by viruses unaffected by antibiotics. 

Across the 14 countries, a third (33%) of respondents consumed antibiotics without a medical prescription, in contrast to 8% of residents in the European Union polled in a similar survey in 2022.

In some countries, more than 40% of the antibiotics were obtained without medical advice.

“Medical expertise is essential to make a correct diagnosis and determine whether antibiotics are the right course of treatment,” WHO Europe stressed.

For some years, the WHO has urged cautious use of antibiotics as pathogens are increasingly developing resistance to them, known as antimicrobial resistance (AMR).

This week is Global AMR Awareness Week. AMR causes an estimated five million deaths annually, with more than half a million deaths occurring in the WHO European Region, which comprises 53 Member States in Europe and Central Asia.  

Different types of antimicrobials – such as antibiotics for bacteria, antivirals for viruses and antifungals for fungi – target specific types of microorganisms. While AMR is a natural phenomenon, the development and spread of superbugs are being accelerated by the misuse of antimicrobials, rendering infections more challenging to treat effectively.  

“The alarming reality is that, without immediate intervention, AMR could result in up to 10 million deaths a year by 2050. Moreover, this burden falls disproportionately on low- and middle-income countries, exacerbating global health inequalities,” according to WHO Europe.

“This research clearly shows the need for education and awareness raising,” said Robb Butler, Director of WHO Europe’s Division of Communicable Diseases, Environment and Health. “All countries in our region have regulations in place to protect precious antibiotics from misuse, for example, preventing over-the-counter sales without a prescription. Enforcing these regulations would solve most antibiotic misuse among humans.”

Image Credits: AMR Industry Alliance.

Pregnant women, newborns and young children are uniquely vulnerable to the effects of climate change.

If government subsidies for fossil fuel were removed and redirected to addressing the impact of climate change on health, this would free up some $6 trillion or 75% of what is spent on health annually, said Agnes Soucat from the French Development Agency.

Soucat also called for scrutiny of agricultural subsidies “and how they contribute to our food system, and how this contributes to biodiversity loss and health impacts, such as impact on diabetes and cardiovascular diseases”.

Governments should eliminate the “harmful subsidy mechanism to reduce or suppress the adverse effect on the environment, animal and human health”, and substitute it with “smart environment and health taxation for one sustainable planetary health”, such as taxes on fossil fuel andcarbon, she proposed.

Soucat also pointed out there there are over 500 public investment banks worldwide with  $2.5 trillion of public investments. If only 10% was “mobilised” for investment in health, this would represent 10 times what is currently available in development aid.

Agnes Soucat from the French Development Agency (AFD).

Soucat was addressing Tuesday’s launch of a Call for Action for policies and action to protect pregnant women, babies and children from climate-related health risks, by United Nations (UN) agencies ahead of the global Conference of the Parties (COP28) negotiations on climate change in Dubai.

According to the Call, climate response policies should prioritise pregnant women, newborns and children, who are particularly vulnerable.

Babies more at risk from air pollution

UNICEF’s Abheet Solomon pointed out that babies “breathe more rapidly than adults while their lungs are still developing”, and this puts them at a greater risk of developing respiratory illnesses when exposed to air pollution.

“This is why, every day 1000 newborns die, simply because of air pollution-related risks,” said Solomon.

“Infants are less able than adults to regulate body temperatures and have a higher metabolic rate, meaning that they’re more susceptible to the effects of extreme heat,” he added. UNICEF estimates that one in three children are currently “highly exposed to heat waves”.

Children’s under-developed immune systems also put them at greater risk of infectious diseases, including malaria and dengue. Meanwhile, children are also vulnerable to natural disasters – one-third of deaths in the recent floods in Pakistan were children.

“When pregnant and lactating mothers are exposed to climate shocks and stresses, the negative effects not only affect their health, but also foetal development,” said Solomon.

UNFPA’s Wllibald Zeck stressed the importance of protecting vulnerable women and girls in the poorest countries who were heavily affected but contributed the least to climate change.UNFPA was also concerned about disruptions to sexual and reproductive health services.

“Climate change is affecting the health of all of us – infectious diseases, non-communicable diseases mental health, of course, heat waves, malnutrition, displacement – everything,” said Maria Neria, the World Health Organization’s (WHO) director of environment.

“It took us at least 10 years to make sure that we have a health day at COP,” added Neria, in reference to 3 December being set aside at COP28 to discuss health and climate.

After this, “no country has an excuse for saying they didn’t know” about the effects of climate on health, said Neria. She  added that the WHO was also pushing for governments to ensure that their health systems are climate-resilient and to mobilise finances to respond to the climate “shock”.

“The causes of climate change and the causes of air pollution, which is killing seven million people every year, are overlapping and relate to the combustion of fossil fuels,” said Neria. “This dependence on fossil fuels needs to stop.” 

The Call to Action was released by WHO, UNICEF and UNFPA alongside an advocacy brief by the Partnership for Maternal, Newborn and Child Health (PMNCH).

The PMNCH advocacy brief reinforces the Call to Action by outlining specific recommendations for different stakeholders – including governments, global financing mechanisms, donors and foundations, private sector and civil society – for ensuring that the health needs of women, children and adolescents are better addressed in climate policies, financing, and programmes.

Image Credits: Michael Duff/ UNFPA.

People seeking shelter at a refugee near the Chad border with Sudan. 

Following seven months of fighting in Sudan, there are outbreaks of cholera, measles, malaria and dengue in the country.

An estimated 6.2 million people – about one in eight – have been forced to flee from their homes since the fighting between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) started in mid-April, according to the UN Office for the Coordination of Humanitarian Affairs (OCHA).

About three million of the displaced people are children, the largest child displacement crisis in the world.

The Office of the High Commission for Human Rights OHCHR has also raised concerns about women and girls being abducted, forcibly married and held for ransom.

“Disease outbreaks are increasing due to the disruption of basic public health services, including disease surveillance, functioning public health laboratories and rapid response teams,” said OCHA in its latest update released on Sunday.

“In addition, insecurity, displacement, limited access to medicines, medical supplies, electricity, and water continue to pose enormous challenges to delivering health care across the country.”

No healthcare services

OCHA estimated that 65-70% of the population lacks access to healthcare, while 70-80%  of hospitals in conflict-affected areas are no longer functional. 

Meanwhile, almost 3,000 suspected cases of cholera, including 95 deaths, have been reported from seven states as of 12 November, according to the Federal Ministry of Health and the World Health Organization (WHO). Other disease outbreaks are ongoing in several states, including measles, malaria and dengue.

Almost 3,000 suspected cases of cholera, including 95 deaths, have been reported from seven states by 12 November, according to the Federal Ministry of Health (FMoH) and the World Health Organization (WHO). Other disease outbreaks are ongoing in several states, including measles, malaria and dengue.

Twenty million people face hunger

Meanwhile, the World Food Programme (WFP) has warned that “over 42% of Sudan’s population – more than 20 million people – face hunger. This is the highest number ever recorded in the country”.

“In addition to conflict, increasing food and fuel prices, the pre-existing economic crisis, protracted displacement, poor harvests and climate shocks, such as floods and droughts, are the main drivers of food insecurity,” reports the WFP, noting that 2023 food prices are 29% higher than last year and 228% higher than two years ago.

UN agencies and NGO partners in the country report that they have only received one-third of the funding that they need to implement the 2023 Sudan Humanitarian Response Plan – $856.2 million of the required US$2.6 billion. 

An estimated 18.1 million people need assistance but humanitarian organisations have reached about 4.5 million people with multi-sectoral life-saving assistance and 5.5 million people with livelihood support since the start of the conflict. 

 

Image Credits: World Food Programme.

Emission
“Present trends are racing our planet down a dead-end 3C temperature rise,” UN Secretary-General Antonio Guterres said on Monday.

The world is on a trajectory to heat up by nearly 3°C this century unless governments take “relentless” action to cut greenhouse gas emissions, according to a new report released Monday by the United Nations Environment Programme (UNEP).

The Emissions Gap report, an annual assessment by UNEP that measures the difference between government pledges to combat climate change and the emissions reductions scientists say are necessary to avert planetary catastrophe, found that current policies are leading to between 2.5°C and 2.9°C of warming above pre-industrial levels by 2100. 

A 3-degree Celsius warming scenario would unleash a cascade of catastrophic consequences, including the displacement of over a billion people, the collapse of ice caps leading to uncontrollable sea level rise, widespread biodiversity loss, frequent and devastating extreme weather events, and the endangerment of critical carbon sinks like the Amazon and Congo Basin rainforests.

The average daily global temperature surpassed 2°C above pre-industrial levels for the first time ever on Friday, marking a historic milestone in the escalating climate crisis as world leaders prepare to gather in Dubai for the annual UN climate summit later this month. 

The 2.06°C average global temperature recorded by the European Union’s Copernicus climate change service on November 17.

“Humanity is breaking all the wrong records when it comes to climate change,” said Inger Andersen, Executive Director of UNEP. “The world must change track, or we will be saying the same thing next year — and the year after, and the year after, like a broken record.” 

The report determined that projected 2030 emissions must be slashed by at least 28-42% compared to current policy scenarios to align with the 2°C and 1.5°C goals of the Paris Agreement, respectively. Even if governments were to fully implement their Nationally Determined Commitments (NDCs) under the Paris Agreement – a big if – warming would still reach 2.9°C, according to the report. 

The current emissions trajectory will see the world exceed the emissions threshold required to meet the 1.5C target by around 22 gigatonnes in 2030 – roughly equivalent to the combined emissions of the United States, China and the European Union. 

“The emissions gap is more like an emissions canyon — a canyon littered with broken promises and broken lives,” UN Secretary-General Antonio Guterres said in a media briefing on Monday. “All this is a failure of leadership and a betrayal of the vulnerable.”

Global GHG emissions under different scenarios and the emissions gap in 2030 and 2035.

Anne Olhoff, the report’s lead scientific editor, stated that the findings remain “essentially unchanged” from last year’s report. The 2022 edition found “no credible pathway” to 1.5°C and concluded that “inadequate progress on climate actions means the rapid transformation of societies is the only option.”

“The only way to maintain a possibility of achieving the temperature goal of the Paris Agreement is to relentlessly strengthen mitigation actions this decade,” said Olhoff. “All countries must urgently accelerate economy-wide low carbon transformations and the transformation of global energy systems.”

With the window of opportunity to avert the worst effects of climate change rapidly narrowing, the reduction targets outlined in the report currently appear far out of reach. In 2022, global greenhouse gas emissions rose by 1.2%, setting a new record of 57.4 Gigatonnes in the planet’s atmosphere. Current projections indicate a mere 2% decline in global emissions from 2019 levels over the same period.

Governments worldwide are planning to produce 110% more fossil fuels in 2030 than is compatible with the 1.5°C target, while the top 20 oil and gas companies alone plan to produce emissions 173% above the 1.5°C target in 2040, according to recent reports by the UN and medical journal The Lancet.

This surge in coal, oil, and gas extraction by governments and private sector fossil fuel companies is set to unleash over 3.5 times the carbon emissions allowed under the 1.5°C warming limit and nearly exhaust the entire carbon budget for 2°C, according to UNEP.

Committed CO2 emissions from existing fossil fuel infrastructure, compared with carbon budgets reflecting the long-term temperature goal of the Paris Agreement.

“Governments can’t keep pledging to cut emissions under the Paris Agreement and then greenlight huge fossil fuel projects,” said Andersen. “It is throwing the global energy transition and humanity’s future into question.”

When the Paris Agreement was ratified in 2015, the probability of global average annual temperatures temporarily surpassing 1.5°C was close to zero. Today, those odds have ballooned to 50% for the 2022-2026 period, according to the World Meteorological Organization (WMO). 

The most optimistic emissions scenario outlined in the Emissions Gap report puts the chance of keeping annual global temperatures below 1.5°C at a mere 14%. The worst-case emissions scenario presented an upper limit of 3.8°C of warming, more than doubling the 1.5°C target set by the Paris Agreement.

“We know it is still possible to make the 1.5°C limit a reality, and we know how to get there,” said Guterres. “We have roadmaps from the International Energy Agency and the IPCC — and it requires tearing out the poison root of the climate crisis: fossil fuels.”

Global greenhouse gas emissions hit a new record of 57.4 Gigatonnes in the planet’s atmosphere in 2022.

A single pyrrhic victory is hidden beneath the gloomy findings of the UNEP report: the Paris Agreement has spurred some, albeit wholly insufficient, action on climate change.

Global greenhouse gas emissions, which were projected to rise by around 16% by 2030 at the time of the Paris Agreement, are now on track to increase by just 3% compared to 2015 levels. Since 2015, a total of 149 signatory countries to the agreement have updated their climate commitments, with nine countries doing so since COP27 in Egypt last year.

These nine countries’ commitments will lead to a reduction of around 0.1 Gigatonnes of emissions. However, to achieve the 2°C pathway, the world must reduce emissions by 18 Gigatonnes, while a 29 Gigatonne decrease is necessary to stay on track for 1.5°C.

Despite the Paris Agreement’s modest progress, the world continues to fall behind on climate action, and records are being broken at an almost monthly rate.

In September 2023, global average temperatures reached 1.8°C above pre-industrial levels, surpassing the previous record by an unprecedented 0.5°C. According to the European Union’s Copernicus Climate Change Service, this year is almost certain to be the warmest on record.

“Leaders cannot delay any longer; we are out of road. COP28 must set us on a path to immediate and dramatic climate action,” said Guterres. “The crucial aspect is our addiction to fossil fuels. It is time to establish a clear phase-out with a time limit linked to 1.5°C.”

Image Credits: UNEP.

A doctor in the DRC examines a patient. Working conditions for doctors are extremely challenging in many African countries.

As the Global North poaches African doctors, healthcare falls to overworked and unmentored interns, some of whom learn medical procedures from YouTube.

Fifteen of the world’s (fiscally) richest countries have over 55,000 African doctors in their health systems, a new data analysis by The Continent shows. These are doctors who qualified before entering those countries. 

The United Kingdom is the top culprit, followed by the United States, France, Canada, Germany and Ireland, in that order. 

Of the African countries being drained of doctors, an analysis of the latest data from the Organisation for Economic Cooperation and Development shows that Egypt has lost the most, followed by Nigeria, South Africa, Algeria and Sudan. 

These countries have consequently paid a significant price in the quality of healthcare they can offer their own residents. 

Egypt, for example, has the lowest doctor-to-patient ratio of its north African neighbours. In many of the drained countries, there are so few trained doctors left that the bulk of healthcare falls to doctors in training: medical interns. 

‘Treated like we are nobody’

Research in Uganda and Kenya details the cost to those interns. The study titled “We were treated like we are nobody” was published this month in the British Medical Journal for Global Health and is based on data on more than 700 medical interns in the two countries, as well as interviews with 54 junior doctors and 14 consultant physicians.

It found that medical interns are suffering from burnout and stress because they are working unreasonable hours and frequently don’t have superiors to train and supervise them. Their working conditions continue to have the same challenges that drive more experienced doctors to seek greener pastures. 

The research found that the lack of support and supervision also “threatened individuals’ well-being and the quality of care being delivered”. 

“Many reported working unreasonable hours – as long as 72 hours – due to staff shortage,” according to Yingxi Zhao, one of the researchers. 

“Sometimes interns were the only staff managing the wards or had to perform certain procedures unsupervised. These included cases where interns had to learn how to perform Caesarean sections from YouTube.” 

Threat to patients’ and doctors’ lives

Such conditions threaten not just the lives of patients but the trainee doctors too. Research by the World Health Organization (WHO) found that people who work 55 or more hours a week had a 35% higher risk of suffering a stroke and a 17% higher risk of dying from ischemic heart disease, compared to those who worked 35-40 hours. 

The Kenya and Uganda findings echo those of a Nigeria study published in May in the Public Library of Science journal. 

Researchers interviewed 628 early career doctors and nearly 40% said they felt overwhelmed by their work. About 16% said they wanted to quit the profession and twice as many said they experienced anxiety. 

The researchers in both studies recommend capping the hours that medical interns and junior doctors work. But limited training facilities and continuing brain drain make the doctor-to-patient ratio so low that reducing working hours is all but impossible. 

By a large margin, the best doctor-to-patient ratios are in Libya and Algeria – 22 and 17 doctors for every 10,000 residents respectively. But even Libya and Algeria compare poorly to the top importers of African doctors, the UK and US, which have between 32 and 37 doctors for every 10,000 people. 

To a doctor looking for a liveable work-life balance, going to the Global North is a no-brainer. 

Lucy Nyokabi, a medical trainee at a Nairobi hospital, says her workload is overwhelming and she often doesn’t have safety equipment or the supplies to do the job properly, like oxygen masks.

“My family supports me in getting the things that I need for the job. I have to remind myself that I need this training to excel at the actual job,” she says.

This makes leaving attractive: “We all hope to work outside the country. I believe the conditions are better out there.” 

First published in The Continent. Subscribe to this free weekly newspaper by emailing read@thecontinent.org

Image Credits: DNDi.