Helping vulnerable populations get access to energy options that reduce air pollution during cooking is an easy way to cut carbon emissions while also improving health and gender equity

Improving access to clean cooking will not only help the world get closer to net-zero carbon emissions by 2050, but it will not be possible to reach the 2030 Sustainable Development Goals (SDGs) without doing so, said experts speaking on the sidelines of COP28. 

“We don’t want people to be breathing polluted air as a result of the fact that they are preparing food,” said Maria Neira, the World Health Organization’s (WHO) Director of Environment, Climate Change and Health.

Globally around 2.3 billion people rely on polluting traditional fuels like wood and biomass for cooking, according to the latest report by WHO. It estimates that the cooking sector contributes 3% to the annual global carbon emissions.

It also causes tremendous indoor air pollution. In 2022 alone, indoor air pollution was estimated to be responsible for 3.2 million deaths, according to WHO. 

Women and children are particularly vulnerable as in many cultures they are responsible for cooking and related chores like gathering firewood. Air pollution is also linked to a rise in miscarriages and worsens pregnancy outcomes. 

The lack of clean cooking is a human rights issue, especially for women and children, said Bhushan Tuladhar, Chief of Party of USAID Clean Air in Nepal.

 “There are so many co-benefits associated with it that it’s almost a no-brainer. And it’s a low-hanging fruit,” he told a COP28 side event on a just and inclusive cooking transition.

The impact of indoor air pollution on women’s health has only in recent years garnered some attention, despite clear evidence of it.

 

Bhushan Tuladhar, an air pollution expert from Nepal.

In addition, cooking with biomass leads to the release of a sooty black material called black carbon. In fragile ecosystems like the Himalayan country of Nepal, this black carbon settles on the glacier ice and increases the rate of melting.

“It’s not just about climate benefit, but when you are reducing black carbon emissions, you’re also not altering your monsoon seasons. There’s energy and agricultural security, and food security is being impacted by this emission,” Michael Johnson, Technical Director of Berkeley Air Monitoring Group, told the event.

The $2.3 trillion cost of inaction

WHO estimates that 1.9 billion people will not have access to clean cooking by 2030 if the pace of improving access is not accelerated. 

In its report titled, “Achieving universal access and net-zero emissions by 2050,” WHO estimates that the annual cost of the impacts of lack of clean cooking on health, gender, and the global climate is US$2.4 trillion.

“Lifting the world’s 2.3 billion people still living in cooking poverty, as we call it, is an urgent issue. And it has enormous potential for societal benefits, particularly for public health, women’s productivity, empowerment, climate and environment. The important thing is the cost of inaction is a staggering US$2.4 trillion given all the damages this can cause,” said Chandrasekhar Govindarajalu, an energy specialist at the World Bank. 

 

Chandrasekhar Govindarajalu of the World Bank said the bank is working to improve access to clean cooking in 33 countries, and its support has reached 43 million people.

Need for clean cooking in sub-Saharan Africa

Access to clean cooking fuels has improved around the world. In Asia, governments have been pushing policies to improve access to LPG cylinders and electric stoves. 

In Nepal for instance, now 54% of the households rely on biomass compared to 75% 10 years back, due to the government initiative to improve LPG access, Tuladhar said. In India, the world’s most populous country, government push improved LPG access from 43.8% in 2016 to 58.6% in 2021. While the numbers are higher for urban households, rural areas continue to lag. 

But in sub-Saharan Africa, the number of people without access to clean cooking has increased. “Population growth has outpaced these improvements, particularly in Sub-Saharan Africa where the number of people without access reached 0.9 billion in 2021,” according to WHO’s report. 

 

The number of people without access to clean cooking is the highest in sub-Saharan Africa, as the growth of population has outpaced rate of the growth of access.


Govindarajalu added that to meet the climate and energy access targets, the rate at which access to clean cooking is currently improving has to be double or triple.

Alternate options: LPG and electric stoves

The two options for clean cooking to replace traditional fuel are electric stoves and LPG cylinders. Both have their challenges, especially in rural areas. While for electric stoves one needs steady and reliable electricity, it is hard to lug LPG cylinders across rural and mountainous terrain. 

Tuladhar said electric stoves are proving to be cheaper in Nepal’s rural areas but electricity access is not yet 100% and the intensity of electricity is not adequate in all areas. 

WHO too estimates that while LPG access will improve in the near term, in the long term it will be the electric stoves that will have to be employed to reduce emissions.  

WHO’s roadmap to help the cooking sector get to net-zero carbon emissions.

Tuladhar told Health Policy Watch that while soon the focus will have to be to increase LPG access, in the long-term it is electric stoves that will bring the maximum reduction in air pollution and carbon emissions. They can only be pushed once electricity access improves.  

Countries are also including clean cooking as a part of their national climate targets, said Johnson which is a good move but its impact is hard to measure, and each country is currently using their own frameworks to do so.

Experts reiterated that the issue of clean cooking is closely linked to the development of the country. “When it comes to energy transition there is no silver bullet, and clean cooking has to be part of the solution, especially as an issue that is so anchored to the development of the country,” said Duccio Tenti, UNDP’s energy team leader

Image Credits: Aalok Atreya/ Unsplash.

Despite strong evidence that taxing alcohol is one of the “most effective measures to reduce consumption and address alcohol-related harms”, countries are not using this effectively, according to Ruediger Krech, the World Health Organization’s (WHO) director of health promotion.

Krech was speaking on Tuesday at the launch of a WHO manual on alcohol tax policy and administration and a report on sugar-sweetened beverage (SSB) taxes. 

“Alcohol is one of the few toxic and psychoactive substances that many governments permit to be sold widely in the market. However, with this permission comes responsibility and governments have a duty to regulate the market to minimise harm,” said Krech.

“Alcohol is one of the leading risk factors for non-communicable diseases, including cancers and cardiovascular diseases. It is also associated with communicable diseases, prenatal conditions, injuries, drowning, mental health conditions and violence. Given the extensive list of harmful effects, addressing the harmful use of alcohol is a priority for the World Health Organization.”

At least 148 countries have applied excise taxes to alcoholic drinks, but wine is exempted in at least 22 countries, mostly in Europe. 

Meanwhile, around 108 countries are taxing some sort of sugar-sweetened beverages but the global average is a low 6.6%. In addition, half of all countries taxing SSBs are also taxing water, which is not recommended by WHO. 

The alcohol manual provides data from the tax systems of different countries as well as advice on the different tax options and their administration. It is the third in a series of WHO manuals on harmful products, with previous manuals addressing tobacco and SSB taxes.

Underwhelming

Devora Kestel, WHO’s director of Mental Health and Substance Abuse, said that while alcohol was linked to over 200 health conditions and had “far-reaching and often devastating effects”, progress to curb consumption at a country level has been “underwhelming”. 

“The global average of alcohol consumed per person has only seen a marginal decline, highlighting the need for more impactful action,” said Kestel.

Furthermore, the World Bank’s Ceren Ozer pointed out, “in high and low and middle-income countries, alcohol has become more affordable over the last three decades”. 

Moreover, the industry is expecting serious growth in the consumption of alcoholic beverages across the board, she added.

Yet alcohol taxes contributed only about 0.3% of GDP in tax revenue globally, which is about half that of tobacco taxes. However, a few countries have shown progress, said Ozer. 

“For instance, in the Philippines between 2012 and 2020, alcohol excise revenue has increased by 140% in real inflation-adjusted terms following significant increases in beer and spirits excise taxes,” said Ozer.

“South Africa is another country where we have detailed data-driven research that shows improvement not only to revenue but also the health impact due to improvements to after alcohol tax design and increasing in rates leading to significant gains from the late 1990s to recent years,” said Ozer.

South African Treasury official Mpho Legote told the launch that as his country taxed the alcohol content of beverages (as opposed to the size as in some countries), this had “incentivized the industry to introduce lower alcohol beers”, for example.

South African Treasury official Mpho Legote.

Improvements in Kosovo and Lithuania

Kosovo has had a “dramatic increase in revenue” almost entirely due to improvements in tax administration, and tax compliance, with an increase of almost a 25% in alcohol tax revenue between 2019 and 2022, Ozer said.

Meanwhile, Lithuania increased alcohol tax revenue from €234 million in 2016 to €323 million in 2018 and saw alcohol-related deaths drop from 23.4 per 100 000 people in 2016 to 18.1 per 100 000 people in 2018, according to WHO.

“About 0.5% to almost 2% of the country’s GDP is lost every year due to alcohol consumption or alcohol use,” pointed out Odd Hanssen, a health economist with the United Nations Development Program (UNDEP,

“This comes from a couple of ways, mainly in what health systems have to spend in order to treat people who have alcohol-caused diseases, but more significantly, the indirect costs of people with these diseases who are unable to work as productively,” said Hanssen.

No ‘one size fits all’

Explaining the manual’s key messages, the WHO’s Jeremias Paul said that “there is really no one size fits all given the heterogeneity of alcohol beverages and tax structures.

Each country’s context was different, and governments had to “consider several factors, such as the patterns of consumption, the administrative capacity, the different kinds of alcohol, beverages available, the policy goals of a country and the political economy and industry structure”, said Paul.

The bottom line, however, was that “the taxes should be high enough to impact affordability”, said Paul.

“One thing for sure is that you can expect industry pushback to reform and in the manual you can essentially find tips. What are the typical industry arguments against tax increases, and how to counter them.”

Image Credits: Taylor Brandon/ Unsplash.

pandemic
Health workers donning personal protective equipment during the COVID-19 pandemic.

This is a bumper week for pandemic negotiations – the last formal set for the year – with meetings of both the World Health Organization’s (WHO) intergovernmental negotiating body (INB) and the Working Group on Amendments to the International Health Regulations (WGIHR).

The INB, which is negotiating a pandemic agreement, meets until Wednesday, while the WGIHR meets on Thursday and Friday.

The proximity of the meetings is intentional, as it enables negotiating teams to attend one another’s meetings to ensure synergy between the two processes.

The International Health Regulations (IHR) define the processes leading to the declaration by the WHO Director General of a public health emergency of international concern and member states’ responsibilities. They are the only global internally binding obligations related to health emergencies.

The pandemic agreement is due to map out pandemic prevention, preparedness and response based on equity, and establish the institutional requirements to achieve this.

INB focus

INB co-chairs Roland Driece and Precious Matsoso

Unlike previous INB meetings, this week’s session did not start with an open plenary as the meeting is considered to be a continuation of the seventh meeting, which started a month ago. In the intervening period, member states have been meeting to discuss various issues related to the negotiating text for the pandemic agreement.

This week’s INB started with several sub-groups looking at key issues on Monday, including pandemic prevention and surveillance, One Health and preparedness, readiness and resilience (Articles 4-6); sustainable production and tech transfer (10-11),  access and benefit sharing (12), global supply chains (13)  Implementation capacity and financing (19-20).

Plenary sessions on Tuesday and Wednesday will consider member states’ text submissions on several of the articles that have been discussed since the previously discussed, including the contentious research and development article, as well as terminology and institutional arrangements needed to implement the agreement.

The INB will conclude with an open plenary to report back to stakeholders who are not part of the INB on Wednesday afternoon.

Meanwhile, Geneva Health Files reported recently that Namibia’s representative at the INB – an articulate champion of equity – had been sent home at short notice and that sources had speculated that wealthier countries may have applied pressure on the small African country to do so.

However, the US and the European Union denied this. Interestingly, Namibia’s response to GHF did not deny that they had come under pressure to recall their diplomat but simply indicated that his term had ended and that Namibia was a sovereign country.

The INB has to conclude its work in time to present the draft pandemic agreement to the next World Health Assembly in May 2024.

WGIHR agenda

WGIHR co-chairs Dr Ashley Bloomfield and Dr Abdullah M Assiri.

According to the WGIHR draft programme of work, the closed-door meeting will begin on Thursday with the co-chairs proposing a way forward to address the amendments received. It will then proceed to discuss text proposals received for several articles, including the proposal by Bangladesh and the Africa Goup for Article 13A on “equitable access to health products, technologies and know-how for public health response” the establishment pf an implementation committee (also proposed by the Africa Group) and the compliance committee (US proposal).

The co-chairs will also introduce the Bureau’s text proposals for a number of articles  and annexes and facilitate discussion on these proposals. This includes the heart of the IHR – the “assessment and notification of events that may constitute a public health emergency of international concern”.

The WGIHR is due to report to the WHO’s executive board on 22 January 2024.

Image Credits: Tehran Heart Centre .

Bhavreen Kandhari of Warrior Moms at a meeting during the UN General Assembly in New York, September, 2023.

Two mothers battled air pollution in Delhi and its suburbs well before it became a thing. Motivated by how their children have suffered,  Ruchika Sethi Takkar and Bhavreen Kandhari speak with Health Policy Watch about why they don’t give up and what other parents can learn from their work. 

DELHI, India – On a gently rolling field of garbage next to swanky high-rises, Ruchika Sethi Takkar bends to look closely at a piece of wrapping. “Sometimes you can trace where a load of garbage came from,” the 51-year-old says, sounding like a veteran detective. She’s standing by the side of a major road in the Delhi suburb of Gurugram. 

Takkar’s no detective nor did she ever imagine that she would often stand ankle-deep in rubbish. She’s the driving force behind Citizens For Clean Air Bharat, a small loose grouping of Gurugram residents.   

Ruchika Sethi Takkar standing on a garbage dump, where she looks for addresses to trace the source. For several years she’s been pushing authorities to prevent open dumping and burning of rubbish in Gurugram.

Bhavreen Kandhari is a more familiar face in India, often seen on national television and quoted in reports about air pollution. Based in Delhi, Kandhari, also 51 years old, began Warrior Moms with a few others. 

Both women aim to improve the quality of air in India, something that more and more people across the country are increasingly concerned about. In the most recent global rankings, 39 out of 50 of India’s major 50 cities were listed as the most polluted in the world.

But Takkar and Kandhari’s journeys began over 20 years ago, at least a decade before the air pollution crisis hit the headlines in 2014 when the World Health Organization (WHO) ranked Delhi as the most polluted city in the world – worse than Beijing, which until then had held the top pollution spot. 

There are striking commonalities in their paths, and Takkar and Kandhari’s learnings may be seen as useful case studies at a time when citizen activism is rising. Be it their organisational approach, their strategies, their negotiations with authorities or even the harsh pushback they’ve faced at times because of their, self-admittedly, privileged background.  

‘My world collapsed months after my daughter was born’

In 2001, Takkar was pregnant and heading an export team doing over $10 million in business annually. Her daughter was born on her 30th birthday. Within a couple of weeks, the new parents realised there were “issues” with their baby. Their doctor advised tests and, when she turned three months, he broke the news to Takkar. She recounts, “He said: ‘Your daughter has mental retardation’. And at that point, my world just collapsed.” =

Apart from the many things Takkar had to deal with, including giving up her job to care full-time for her infant, she wanted to understand what happened. Her doctor said it could be a neurodevelopmental disorder and the foetus had microcephaly, described as a birth defect where the baby has a small head.

Genetic profiling tests gave no indication of what caused it. During her pregnancy, Takkar had been diagnosed with intrauterine growth retardation (IUGR), and doctors noted that the foetus wasn’t growing that well. But the ultrasound didn’t flag anything, she recalls.

Looking back, she wonders whether the fumes from a diesel generator she was exposed to in the early months of her pregnancy could have been the cause. There were power outages at her office and fumes used to “flood in” though she accepts it’s hard to pin blame on this alone. Studies have linked IUGR, developmental disorders and other conditions to air pollution.

Soon, Takkar’s baby developed frequent respiratory ailments and had to use a nebuliser. It made Takkar aware of their surroundings. At the time they lived a short drive from a massive landfill in east Delhi. 

“I was aware that there is something in the environment also which is not helping. It was known that Noida [a suburb in east Delhi] has much more industrial pollution even next to the residential area. But still, I had no idea about municipal laws and environmental laws. All I knew was that the children were now being diagnosed a lot with asthmatic conditions.”

November 2023 saw average PM 2.5 levels in four cities including Delhi hit a five-year high.

By 2011, Takkar’s family had shifted to Gurugram, bordering south Delhi, to an up-market residential complex. But she frequently noticed a burning smell and was in for a rude surprise. It was waste being burnt next to their complex from their complex that had been dumped there by the builders. The rude surprise wasn’t just this but the apathy of some of her neighbours. One of them told her: ‘Why bother, you can just pop a medicine’. 

The following year Takkar started a group called Malba Hatao Movement (‘Remove Garbage Movement’.) It drew her into a maze of red tape and direct contact with three major government departments – the district administration, city municipality and building regulator. 

Three long years later, she had her first success when two departments banned the burning of waste, Takkar proudly recollects. All she had done was read the rules. “There came this realisation that the law is there, but for it to work you need more voices.”

Takkar’s biggest breakthrough came when she managed to get the top bureaucrats of the three departments into the same meeting in November 2015. They had one agenda: to stop waste burning in Gurugram, and they agreed to start pilot projects. 

Before setting up this meeting, Takkar made progress with two other stakeholders. First, more residents began to see waste burning as a health risk not as a solution to waste. She conducted over a dozen roadshows which meant taking residents to garbage dumps to drive home both the problem and solution. 

Her second success was using the simpler and more sidely understood word, pollution:  “The press kept focusing on the seasonal factors but not the persistent local factors which I had started coining as pollution because nobody else was picking up the word ‘civic deficiencies’.” 

However, eight years later, waste burning remains rampant in Gurugram. Takkar and other citizens frequently complain either directly to officers or on social media, tagging top ministers and the press. If there are any gains from those years of activism then it is that the administration is more responsive – although whether their responses are sufficient is another matter. 

In 2016, Takkar started a new group, Citizens for Clean Air Bharat. A loosely organised collective with no funding or organisation structure, the group frequently reports open burning to officials and politicians in charge. 

‘Something not right’

Bhavreen Kandhari in front of Delhi’s iconic Jawharlal Nehru Stadium.

Bhavreen Kandhari’s advocacy for air quality began earlier, after 1995 when frequent trips between Delhi and New York, enabled her to compare the air quality.

“I started kind of feeling that there is something not right in the air. And when I go from here to there [New York], you feel more energetic, and (it’s better for) your skin, and your hair,” said Kandhari, who had begun reading up on the Great Smog of London and California’s battle with air pollution, but could not get data about Delhi’s air. 

After 2002, things changed for Kandhari. Her twin girls were born prematurely at just six months and weighed 600 grams each and spent several weeks in hospital. From their first year, they began getting coughs and colds. 

“After three to four years, I realised that their colds and coughs don’t go away easily. They start around the same time year after year,” she said.

But when the children were taken to New York, from “the moment you land there, (their coughs and colds) would go away magically. The elders would always blame allergies. But now I was sure. This is something really about the air.” 

Around 2007-08, she participated in small protests outside India’s Ministry of the Environment demanding policy action for clean air – but there was little resonance amongst the public or the press, which she blamed on the absence of data. 

That information gap began to be addressed around 2011 when a Delhi-based think-tank started advising Kandhari. The tipping point for her clean air advocacy came after the WHO’s 2014 shock listing of Delhi as the world’s most polluted city.

‘Elite’ protest

Kandhari and a few other organisers decided to protest in the heart of Delhi, at a designated protest spot near Parliament in November 2016. While a couple of hundred people showed up, some of them arrived in diesel SUVs which are notorious for spewing pollution. “Many of our cars were photographed, and the media said that they are the elite mothers coming for this thing.”

The elite tag is something both Takkar and Kandhari have faced from several stakeholders. Both are self-funded, and both their fathers were in government service – one in the top bureaucracy and the other in the air force. Both belong to the ‘cream’ of civil society, and are urbane and well-off. And both could see that their approach needed to change. 

Kandhari admits the protest with SUVs “was my game changer. I thought that yes, this movement cannot be elite, it has to have masses with us. The biggest mistake I think I was making those days was not writing much in Hindi.”

Takkar says she was already working a lot with Hindi newspapers. She positioned the air problem and her campaign simply, as a “dhool aur dhooyen ki kahaani” – a story of dust and smoke – something that’s tangible. 

Providing a template for complaints

Widening the social net took their work to a new level. “What I could sense is that if government officials think that only a few people are bothered about it, then they don’t think it’s a problem. Then they think it’s your fetish, it’s your pastime,” says Takkar.

The outreach led her to adopt a new approach for those approaching her with pollution complaints. “That’s where my time goes, just talking to people and then telling them how to go about it. What bothered me was they would expect me to solve their problems. I said: ‘It can’t be done this way. I will give you a template. This is the number, this is the email’.” 

Kandhari says that, as she has been campaigning for clean air for a long time, she can help others. “Air pollution is a problem in different cities. But I can’t manage that. I have no resources. I can just connect people.” 

It led her and a few others to set up Warrior Moms in 2020, ironically because of blue skies instead of haze. The COVID-19 lockdowns showed how removing cars and several other sources of pollution could lead to blue skies. 

“It was the world’s biggest experiment, you know, a natural experiment showing us that it’s the emissions and it was so easy for us to prove. But we couldn’t go out.” 

Warrior Moms was born out of this need. It grew from a core of about five groups to almost 20 today with a membership of over 1,700, especially when pollution is high. ‘

But it is all voluntary work. There’s no structured membership and people can join or leave depending on their requirements. It’s essentially now a knowledge and support network as more people, including top personalities, voice their concerns about air pollution. 

Cricket stars troubled by air pollution

During the recent Cricket World Cup hosted by India, air pollution levels started to peak. India’s cricker captain, Rohit Sharma, expressed concern about air pollution in Mumbai when he landed for a match: “Looking at our future generations, your kids, my kid, obviously it is important that they get to live without any fear. Every time I get to speak outside of cricket, or not discussing cricket, I always talk about this. We have to look after our future generations.” 

England’s Joe Root, said following his team’s defeat to South Africa in Mumbai. “I’ve not played in anything like that before,” Root had said. “It just felt like you couldn’t get your breath. It was like you were eating the air. It was unique.” 

The teams playing in Delhi were worse off. The comments forced the organisers to acknowledge the poor air quality in Delhi and Mumbai. 

After 20 years with little progress, why not give up? 

Since Takkar and Kandhari began their advocacy work,  air quality has barely improved especially between October to March. The waste burning continues, and they have little or no financial or logistical support. Why don’t they just give up? 

For the first time in an hour-long interview, Takkar pauses. Her eyes well up. “You know, you just need to live with my daughter for a day. She’s getting nothing back from this society. Nothing. Yet, I think you have to make do with what you have.” 

After another pause, she continues: “There is always somebody out there who is weaker, who is getting affected. So we need to recognize, I think just by virtue of the fact that we are alive and we have some abilities, we have to do better for our lot.”

The Gurugram mom wants fellow residents to ask questions about their welfare. “We have data which is coming in about the non-communicable diseases (NCDs) growing, your own loved ones… you don’t have answers, where did (that) cancer come from?

“I don’t think anybody should give up. But yes, I do feel exhausted now, especially with the courts and all that,” Bhavreen Kandhari says, referring to her work petitioning courts to protect trees in the Capital. 

Kandhari speaks of tense times at home when her husband’s business hit a rough patch. They came through that but she’s determined to continue accepting that she’s not indispensable. 

“Everyone’s looking towards each other. I’ve always looked up to so many people. That’s how people are looking up to me. And how can we do this? How can we allow… I mean, if I’m angry, I am angry that, yeah, what you said, 20 years. And my girls are turning 20 and I have not been able to give them clean air and only damaged lungs.” 

Image Credits: Chetan Bhattacharji, Respirer Reports.

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.”