Flagship UN report finds irreversible damage to global water systems affects three-quarters of the global population, threatens food security and thrusts the world into a new era of the water crisis.

The world has entered the era of “global water bankruptcy” as water systems relied on by six billion people, and half of the world’s food production, are pushed beyond the point of recovery, a United Nations (UN) report has found.

The report marks the first time UN scientists have declared water systems “bankrupt” rather than “stressed or “in crisis”, a distinction that denotes irreversible damage to natural water systems, as opposed to acute, time-limited shortages due to factors like weather, high demand or economic shocks.

“This report tells an uncomfortable truth: many regions are living beyond their hydrological means, and many critical water systems are already bankrupt,” said Kaveh Madani, director of the UN University’s Institute for Water, Environment and Health and lead author of the report.

“If we continue to manage these failures as temporary crises with short-term fixes, we will only deepen the ecological damage and fuel social conflicts,” Madani said. “We must act because water bankruptcy is a justice and security issue. The cost of the hydrological overshoot that the world is facing falls disproportionately on those who can least afford it.”

The UN report arrived ahead of high-level meetings in Dakar, Senegal, this week to prepare the agenda for the 2026 UN Water Conference, set for December in the UAE. It calls on member states to formally recognise water bankruptcy, establish global monitoring frameworks and position water investments as fundamental to achieving climate, biodiversity and food security targets.

This year’s summit is only the second major international meeting on water governance this century, following a 2023 summit at UN headquarters in New York. The only other global water conference in history was held in Mar del Plata, Argentina, in 1977.

“Declaring bankruptcy is not about giving up, it is about starting fresh. By acknowledging the reality of water bankruptcy, we can finally make the hard choices that will protect people, economies, and ecosystems,” Madani said. “The longer we delay, the deeper the deficit grows.”

‘Day Zero’ threatens major cities

The world’s third largest lake, the Aral Sea, lying between Kazakhstan and Uzbekistan in 1989 (left) and in 2025 (right).

The UN report draws on satellite data, hydrological modelling and over 300 case studies to document the scale of water loss.

More than half of the world’s large lakes have lost water since the early 1990s, over 30% of glacier mass since 1970 has disappeared in certain regions, while about 410 million hectares of natural wetlands—a land mass nearly equal to that of the European Union—have been destroyed over the past five decades.

“Surface waters are shrinking. Those are our checking accounts that get renewed every year, that nature is kind enough and generous enough to deposit some budget, give us some income,” Madani explained. “It is normal to go to the savings account and buy resilience for the dry years. But what we are seeing around the world is that the savings accounts are also draining – we are exhausting them.”

The Middle East, North Africa, South Asian and parts of the American Southwest face the most severe threat as high water stress collides with extreme vulnerability to climate change. Over 1.42 billion people, including 450 million children, already live in conditions of high or extremely high water vulnerability, according to UN Water data.

Water scarcity has been a major driver of public outrage at Iran’s regime throughout the recent wave of protests. After six years of drought, reservoirs around its capital, Tehran, are on the brink of the next “Day Zero” event. / Satellite image: Institute for the Study of War.

For some of the world’s largest cities, the crisis has already arrived. Metropolises around the globe, from Cape Town to Sao Paolo and Tehran, have already faced their first “Day Zero” emergencies – events where water supplies for a city are near complete depletion. Kabul, meanwhile, is on the brink of becoming the first major city globally to run out of water.

While cities survived, these first “Day Zero” events are warning shots, and many – particularly the urban poor – continue to live with the consequences, the UN warned.

“Emergency measures—severe restrictions, tariff changes, rapid drilling of new wells, reliance on tanker supplies, and behavioural campaigns—helped some cities narrowly avoid a complete shutdown of taps,” the report found.

“Yet in many of these places, the underlying aquifers, reservoirs and catchments remain degraded, and poorer neighbourhoods continue to live with intermittent service, tanker dependence, and high water costs long after the media attention has moved on.” 

Half the world’s 100 largest cities experience high water stress, while 38 – including Beijing, New York, Delhi, Los Angeles and Rio de Janeiro – face “extremely high stress” levels, according to a separate analysis published by Watershed Investigations this week.

Another study published this year by the University of Utrecht, analysing 21 global water scarcity hot spots, found that hydroclimatic change – long-term changes in water cycles driven by climate change – was cited in 49% of case studies, but typically was not the sole driver of scarcity, operating alongside population growth (31% of cases), agricultural overuse (77%), industrial demand (30%) and municipal consumption (46%).

Disease and displacement

Water access is a fundamental determinant of health, yet nearly 2.2 billion people lack safely managed drinking water, while 3.5 billion lack safely managed sanitation, according to WHO figures. 

These gaps expose populations to cholera, typhoid, polio, dysentery, hepatitis A and diarrhoea. Waterborne diseases and inadequate water supplies kill an estimated 3.5 million people annually, according to UN Water. WHO research estimates that 900 children under five per day die from diarrheal diseases caused by unsafe water.  That is one child every two minutes, adding up to 328,500 deaths every year.

About four billion people—nearly two-thirds of the global population—face severe water scarcity for at least one month every year, forcing communities to use water contaminated with agricultural runoff, industrial waste and untreated sewage for basic health activities such as handwashing and bathing. This amplifies the breeding grounds for infectious waterborne disease spread and raises risks of poisoning from chemicals like lead or arsenic.

Water scarcity also drives displacement, which cascades into health crises as populations move into areas with inadequate sanitation, limited healthcare and overcrowded conditions that accelerate health risks. Over 700 million people are projected to be displaced by water scarcity by 2030, according to UNICEF.

“Bankruptcy management requires honesty, courage, and political will,” Madani said. “We cannot rebuild vanished glaciers or reinflate acutely compacted aquifers. But we can prevent further loss of our remaining natural capital, and redesign institutions to live within new hydrological limits.”

Water-driven conflicts rise

Water-related violence has nearly doubled since 2022, rising from 235 incidents to 419 in 2024, according to Water Conflict Chronology, a database updated this week by the Pacific Institute that tracks water-driven violence throughout history.

The dataset contains 2,757 conflicts dating back to a dispute in ancient Sumeria over water and irrigation that led to nearly a century of war in 2500BC. The latest incident added documents of residents punching and beating firefighters in Manila, Philippines, blaming them for a lack of water.

Water has increasingly been a target in major wars, despite Article 54 of the Geneva Convention classifying attacks or destruction of water infrastructure or supplies necessary for civilian survival as a war crime.

Recent examples include Israel’s systematic destruction of Gaza’s water systems and desalination plants, Russia targeting hydropower dams in Ukraine, and tensions over the Indus River treaty between India and Pakistan, the report found.

Water Conflict Chronology’s tracker lists nearly 3,000 wars over water since 2500BC.

Oxfam’s water security lead, Joanna Trevor, told the Guardian that her team has observed “an increase in localised conflicts over water due to climate change and water insecurity” as competition for dwindling reserves intensifies.

“In East Africa and the Sahel, water is becoming increasingly insecure, and people are moving into new areas to access water, which in itself can trigger competition and conflict with the host population,” Trevor said.

UNICEF estimates that by 2040, roughly one in four children—about 450 million—will live in areas of extremely high water stress.

“Water bankruptcy is becoming a driver of fragility, displacement and conflict,” said Tshilidzi Marwala, UN Under-Secretary-General. “Managing it fairly is now central to maintaining peace, stability and social cohesion.”

Food systems dry up

Total freshwater withdrawals for agriculture, industry and domestic uses across the globe from 1900 to 2010.

Three billion people and more than half of global food production are concentrated in areas where total water storage is already declining or unstable, according to the report.

With agriculture accounting for an estimated 72% of global freshwater withdrawals, the report’s concern is echoed by recent research by the World Resources Institute (WRI), which found 25% of the world’s crops are grown in areas where water supply is highly stressed or unreliable.

“One out of every 11 people in the world grapples with hunger,” WRI found. “A hidden and growing driver is lack of water.”

As water stress soars, the world will need to produce 56% more food calories in 2050 than it did in 2010 to feed a projected population boom to 10 billion people.

Yet current production is already under threat: one-third of rice, wheat and corn produced globally—which provide more than half of global food calories—is grown in water-stressed regions, while irrigation water demand is forecast to increase 16% over the next two decades due to warming temperatures, according to WRI.

“We need to decouple growth from water,” Madani said. “We need to move away from the asumption that economic prosperit requires ever-increasing water withdrawals – the problem that has got us in this situation.”

Just 10 countries produce 72% of the world’s irrigated crops, with two-thirds of that production facing high to extremely high water stress. India, the world’s largest rice exporter, is losing up to 30 centimeters of groundwater per year in some regions, with depletion rates projected to triple by 2080.

Over 170 million hectares of irrigated cropland—equivalent to the combined land area of France, Spain, Germany and Italy—are under high or very high water stress. An additional 106 million hectares have been degraded by salinisation, the UN report found.

“Millions of farmers are trying to grow more food from shrinking, polluted or disappearing water sources,” Madani said. “Without rapid transitions toward water-smart agriculture, water bankruptcy will spread rapidly.”

“Despite its warnings, the report is not a statement of hopelessness,” he concluded. “It is a call for honesty, realism, and transformation.”

Image Credits: Art Poskanzer, Institute for the Study of War , Pacific Institute.

WHO flags
The US accused the WHO of “holding hostage” the American flag that once flew outside the Organization’s Geneva headquarters (seen here in 2025).

A dispute over an American flag has become symbolic of the bitter public dispute between the US and the World Health Organization (WHO) after the US withdrew from the organization on 22 January.

In a joint statement by Secretary of State Marco Rubio and Secretary of Health and Human Services Robert F Kennedy Jr on the termination of US membership of the WHO, they accused the organization of keeping the American flag that hung outside its Geneva headquarters captive.

“Even on our way out of the organization, the WHO tarnished and trashed everything that America has done for it. The WHO refuses to hand over the American flag that hung in front of it, arguing it has not approved our withdrawal and, in fact, claims that we owe it compensation. From our days as its primary founder, primary financial backer, and primary champion until now, our final day, the insults to America continue.

“We will get our flag back for the Americans who died alone in nursing homes, the small businesses devastated by WHO-driven restrictions, and the American lives shattered by this organization’s inactivity,” the statement said.

A day after the official withdrawal, the State Department declared victory, posting: “Under @POTUS leadership, the @StateDept and @HHSGov have secured its return, now safely held by U.S. Marines @usmissiongeneva, and on its way back to USA.”

The dispute over the flag underscores broader and long-simmering tensions between the Trump administration and the WHO, particularly over the Organization’s handling of the COVID-19 pandemic.

US still owes WHO $260.6 million

The US’s highest-ranking health officials, including National Institutes of Health director Dr Jay Bhattacharya, rose to prominence during the pandemic for their criticism of COVID-19 policies, tapping into widespread public anger over restrictions, school closures, and vaccine mandates.

In the view of current US leadership, the WHO is an organization “beyond repair.”

Instead, the Trump administration has begun pursuing a series of bilateral agreements with 14 sub-Saharan African countries, aiming to recreate aspects of the WHO’s multilateral system for pooling scientific and public health data.

But according to global health policy experts at Georgetown University, Sam Halabi and Lawrence O Gostin, this “transactional alternative” assumes that the US could strike comparable agreements with nearly every country in the world – “which of course it cannot,” they wrote in a commentary published in the Washington Post.

The WHO is expected to discuss how to address the US withdrawal at its upcoming Executive Board meetings on 2 February and again at the annual World Health Assembly in May. The organization also maintains that the US owes $260.6 million in unpaid membership dues.

WHO says withdrawal makes US and world ‘less safe’

WHO Director General Dr Tedros Adhanom Ghebreyesus at a press briefing in Geneva. Tedros defended the Organization’s COVID-19 response.

The WHO responded to the US’s accusations on Saturday, saying that “[w]hile no organization or government got everything right, WHO stands by its response to this unprecedented global health crisis. Throughout the pandemic, WHO acted quickly, shared all information it had rapidly and transparently with the world, and advised Member States on the basis of the best available evidence.”

WHO Director General Dr Tedros Adhanom Ghebreyesus echoed the sentiment, saying: “While WHO recommended the use of masks, physical distancing and vaccines, WHO did not recommend governments to mandate the use of masks or vaccines and never recommended lockdowns. 

“WHO supported sovereign governments with technical advice and guidance that was developed on the basis of evolving evidence on COVID-19 for them to make policy decisions in the best interests of their citizens. Each government made their own decisions, based on their needs and circumstances.”

The WHO pointed to the US’s global participation in some of the world’s greatest public health achievements, despite the fact that the US promises to continue “leading the world in public health” without collaborating with the UN organization. 

“As a founding member of the World Health Organization, the United States of America has contributed significantly to many of WHO’s greatest achievements, including the eradication of smallpox, and progress against many other public health threats including polio, HIV, Ebola, influenza, tuberculosis, malaria, neglected tropical diseases, antimicrobial resistance, food safety and more.

“WHO therefore regrets the United States’ notification of withdrawal from WHO – a decision that makes both the United States and the world less safe.”

This story is a continuation of Health Policy Watch’s coverage of the US-WHO withdrawal. See related stories here:

Stars and Stripes No Longer Flying at WHO – But US Can’t Really Leave Until Dues are Paid, Agency Says

America First is Not America Absent

 

Image Credits: Arkansas Advocate , E. Fletcher/Health Policy Watch.

Healthcare workers
The mission to ensure safe, effective and affordable diagnostics, therapeutics and vaccines (DTVs) within 100 days of a pandemic threat being identified is not possible in many regions, according to the International Pandemic Preparedness Secretariat.

Global pandemic preparedness is becoming “increasingly fragile at a time of growing biosecurity and geopolitical risk”, according to the International Pandemic Preparedness Secretariat (IPPS), which launched its Fifth Implementation Report of the 100 Days Mission on Tuesday.

IPPS is an independent entity that promotes the “100 Days Mission”, the global ambition to develop safe, effective and affordable diagnostics, therapeutics and vaccines (DTVs) within 100 days of a pandemic threat being identified. 

But pressure on global R&D pipelines, declining investment in pandemic countermeasures, and heavy reliance on a small number of funders mean that the 100-day target is not possible in many areas, according to the report.

“Major reductions in global health and research budgets in 2025 have exposed structural vulnerabilities, disrupted development pipelines, and weakened preparedness,” the IPPS notes in a media release.

“Investment in pandemic countermeasure R&D continued to decline through 2024, with the steepest impacts seen in therapeutics. Pipelines across diagnostics, therapeutics and vaccines remain uneven and clustered in early stages, with limited progression into mid-stage and late-stage development. 

“Progress on enabling systems, including regulatory preparedness, clinical trial readiness, data-sharing frameworks and manufacturing coordination, remains slow,” the media release notes.

Outbreaks of mpox,  a continental health emergency in Africa until last week; the zoonotic spillover risk of H5N1; and outbreaks of Ebola, Marburg, Rift Valley Fever and Chikungunya “have highlighted persistent challenges in early detection, coordination and equitable access to countermeasures”, according to the IPPS, which is funded by the Wellcome Trust and Gates Foundation

“The science needed to respond faster to pandemics continues to advance, but this report makes clear that progress in applying these advances to delivering effective tools is insufficient,” said Dr Mona Nemer, chair of the IPPS Steering Group and Chief Science Adviser of Canada.

“Today, despite the landmark WHO Pandemic Agreement, the world remains vulnerable to funding shocks, uncoordinated R&D efforts and fragile development pipelines – particularly for therapeutics.”

Priorities for 2026

For the first time, the 100-day scorecard includes an assessment of pandemic preparedness and response (PPR) capacity in Africa. 

This evaluates the continent’s capabilities in clinical trials, laboratory systems, regulatory frameworks and manufacturing.

“Advances in platform technologies, including mRNA, monoclonal antibodies and artificial intelligence, continue to offer opportunities to accelerate development,” according to the report, which also identifies “significant pressures”.

However, it notes that Africa shows “growing regulatory maturity and manufacturing capability”. It highlights Rwanda’s integration of the 100 Days Mission framework and scorecard into national preparedness planning as an example of how the mission can be operationalised at the country level.

The report, launched in Paris, identifies 2026 as a decisive year as France begins its G7 presidency.

It  identifies four priority action areas for 2026:

  • Operationalising the Therapeutics Development Coalition to address persistent gaps in antiviral R&D.
  • Enhancing coordination across the diagnostics ecosystem and implementing recommendations from the Global Diagnostics Gap Assessment.
  • Sustaining vaccine investment and strengthening alignment across diagnostics, therapeutics and vaccines.
  • Agreeing on a sustainable mechanism for pandemic preparedness monitoring, including a long-term path for the 100 Days Mission Scorecard beyond the IPPS mandate(which ends in 2027).

 

 

Image Credits: PREZODE , Photo by Carlos Magno on Unsplash.

WHO member states at an Intergovernmental Working Group meeting, negotiating a pathogen access and benefit-sharing (PABS) system.

Only 12 more negotiating days remain until WHO member states hit the May 2026 deadline for an agreement on a Pathogen Access and Benefit Sharing (PABS) system, as part of the new Pandemic Agreement adopted at last year’s World Health Assembly (WHA). 

The gap between developed and developing blocs of countries remains large, and progress has been slow in bridging the divide. A bloc of approximately 100 low-and middle-income countries (LMICs) continues to call for mandatory benefit sharing, including guaranteed LMIC access to vaccines, therapeutics, and diagnostics (VTDs) as the price of their rapid sharing of information on novel pathogens that might pose a pandemic risk.  

High-income countries, on the other hand, remain focused on protecting the pharma innovation ecosystem and ensuring open pharma access to pathogen sequence data. In terms of benefit-sharing, they tend to favor more flexible and voluntary commitments by manufacturers and research institutions to share products and manufacturing know-how with LMICs. 

While some elements of the PABS might actually be settled in time for adoption at  this year’s 79th WHA (18-23 May), other issues are likely to be kicked further down the road, potentially to a future Pandemic Agreement Conference of Parties (COP).  

In the seventh issue of the Governing Pandemics Snapshot, Daniela Morich dissects the choices facing member states.

Longstanding tension between rapid pathogen sharing and access to benefits

Cheers among the lead negotiators as the World Health Assembly adopts the Pandemic Agreement, 20 May 2025

On 20 May 2025, the global health community welcomed the adoption of the Pandemic Agreement (PA) as a much-needed triumph of multilateralism in a year marked by significant challenges and strains on global cooperation.

Although adopted, the Agreement will not be opened for signature until a supplementary Annex on the Pathogen Access and Benefit Sharing (PABS) system is completed—an uncommon feature in international law that temporarily halts the Agreement’s progress toward entry into force until the details of the Annex are agreed.

At the core of the Annex lies a longstanding tension: how to ensure rapid and reliable sharing of pathogens and their genetic sequence data – crucial for managing health emergencies and for the development of health products – while also guaranteeing fair and meaningful access to the benefits derived from their use, such as vaccines and therapeutics.  

Article 12 of the PA sets out the foundational principles of the PABS system. But the specifics – such as the recognition of obligations for countries and manufacturers, benefit-sharing arrangements, and implementation mechanisms – remain to be negotiated. An ad hoc Intergovernmental Working Group (IGWG), open to all WHO member states, has been tasked with translating these principles into operational rules.

Wide divide from the start

Ethiopia representing the position of the Africa group during pandemic agreement negotiations in March 2024.

The IGWG officially began its work in mid-2025. In August, WHO Member States submitted 17 textual proposals reflecting the views of approximately 100 countries. These proposals revealed, from the outset, deep divergences in how countries imagine the PABS System, and those differences have continued to shape the negotiations ever since.  

Developing countries advocate for strong equity provisions, including mandatory benefit-sharing and guaranteed access to vaccines, therapeutics, and diagnostics (VTDs). Their approach relies on transparency and traceability, with a strong role for WHO in administering the system and oversight by a future Conference of the Parties (COP).

Developing country blocs also have placed a greater emphasis  on technology transfer, and as part of that, licensing of medicines and vaccines as core benefits they should reap from the PABS agreement. As such, their proposals prioritize binding obligations operationalized through contractual mechanisms to ensure traceability and enforceability of commitments and to support the development of regional production capacity.

Consistent with this approach, the leading LMIC negotiating blocs, known as the Africa Group and the Group for Equity, as well as Egypt, Libya, Somalia and Sudan jointly submitted an ad hoc proposal for draft contractual agreements for negotiation (see Adam Strobeyko’s piece Avoiding Contract Fatalism.).

High-income countries, by contrast, focus on protecting the innovation ecosystem, maintaining open access to pathogen sequence data, and preserving incentives for private-sector research and development, which is still mainly happening in the Global North.

With regards to benefit-sharing obligations, they tend to favor voluntary and flexible commitments for manufacturers and research institutions. Their concern is that overly rigid obligations could undermine scientific collaboration or discourage investment in pandemic-related technologies.

First draft text does not bridge divides

IGWG3 gets underway on 4 November 2025.

In October 2025, the IGWG’s Bureau, a six-person panel steering the negotiations, released the first Draft Text of the Annex ahead of the Group’s third meeting. Although the text drew significant criticism from many delegations, it nonetheless became the basis for negotiations during the two subsequent meetings in November and December.

Progress was extraordinarily slow. Delegations used the sessions not to narrow differences but to reinsert the language they considered had been omitted from the Bureau’s proposal. As a result, the document expanded from seven pages to 37, producing a dense and unwieldy “rolling text” in which every proposal reappeared.

The only areas where common ground emerged were a few preliminary words on governance elements, notably that the COP would oversee the PABS System and that a PABS Advisory Group would be created.

Following calls for more transparency in the proceedings, the second IGWG meeting marked a surprising shift by deciding, on a pilot basis, to invite stakeholders to observe discussions starting at IGWG3 in November 2025. 

However, this openness was quickly revoked at the beginning of IGWG3, with no access to the negotiating room granted to observers. Further constraints on meaningful participation were introduced in January 2026, when participation was limited to virtual attendance. It is hoped that greater transparency will be allowed as the process moves forward.

Revising the Draft: Gains Limited to Pathogen Definition

The fourth session of the IGWG made some progress in clarifying the definition of a pathogen with pandemic potential. Here, a microscopic view of  SARS-COV-2. 

In the fourth resumed session of the IGWG (20–22 January 2026), progress remained slow. The Bureau, following regular intersessional informal meetings, released a revised draft text.

Some advancement was seen in clarifying language on the definition of “pathogen with pandemic potential,” an important step in defining the system’s scope, but little progress was made elsewhere in the text. Despite a generally positive mood in the room, the ticking clock reinforced a sense of urgency. Progress in bridging the divides continues to be painfully slow.

A small but highly engaged group of relevant stakeholders continues to follow the process closely, although it remains state-led and conducted behind closed doors. Interaction with delegates is limited to short briefings led by the Bureau and is restricted to stakeholders duly accredited to the process.

Are we nearing the finish line?

With the May 2026 deadline approaching – and only 12 actual negotiation days remaining – clear divergences between blocs of countries remain a significant obstacle. 

Additionally, while some issues—such as laboratory networks, databases, and traceability—have been discussed, other critical topics, including financing, have yet to be meaningfully addressed, as highlighted by Suerie Moon in her companion article “Could money grease the wheels of compromise on PABS?”

Against the ticking clock, an overarching  question now looms: which elements of the PABS  parties might be willing to settle now –  and which they might further kick down the road to a future Pandemic Agreement’s COP.

Problematically, these negotiations also unfold against the backdrop of a spate of US  bilateral agreements with  developing countries – so far 15 in all. In these arrangements, seen as a cornerstone of the new US global health policy, aid and commercial deals are offered in exchange for access to pathogen samples and data about disease outbreaks. 

Some experts worry that these deals will negatively affect the negotiations in Geneva, and the future PABS systems, as they could create structural dependency that constrains a country’s ability to share data independently with regional or WHO-coordinated networks.

With only a few months remaining, parties will need to be realistic about what can be achieved. Successfully concluding this work would consolidate years of effort and strengthen the foundations of a more equitable global pandemic preparedness and response system.

Daniela Morich is head of policy engagement and Global Health Platform at the Geneva Graduate Institute’s Global Health Centre.

Explore the three other articles available in the seventh issue of the Governing Pandemics Snapshot:

In  “Avoiding Contractual Fatalism: Lessons from PIP Framework for Standardising PABS contracts” Adam Strobeyko looks at how the experience of the Pandemic Influence Preparedness (PIP) Framework could help inform the PABS process. He examines WHO contracts that enable pharma access to a global network of influenza samples in exchange for benefit-sharing commitments channelled through WHO.

In PABS laboratory networks: building a new system or using what we have? Gian Luca Burci examines whether existing WHO-managed networks, such as the Global Influenza Surveillance and Response System (GISRS), could take on the additional role of a PABS laboratory network, presuming an agreement is reached.

Finally, in her piece, Could money grease the wheels of compromise on PABS? Suerie Moon explores how finance for Access and Benefit Sharing (ABS) could be generated in “interpandemic” times when the absence of a clear pandemic threat provides limited incentive to pharma companies to invest in related products. 

Image Credits: NIAID-RML .

Women are being taught how to access information about contraception on their smartphones in Indonesia. The UN’s Universal Periodic Review (UPR) provides an avenue for human rights activists to advocate for more rights for citizens.

Grassroots organising, using the United Nations’ Universal Periodic Review (UPR) and creating new multilateral coordination are some of the ways to counter the current attack on sexual and reproductive health (SRH), according to activists.

There is a “rise of unapologetic, unabashed, hegemonic masculinity and really harmful gender stereotypes,” Paola Salwan Daher, Women Deliver’s senior director for collective action, told a webinar on the anti-rights pushback.

Far-right governments “are bringing the message that women should not have the same rights as men,” and tech billionaires “have put their incommensurable wealth behind this”, she added.

“We are seeing deeply biased misinformation around women’s bodies, around women’s health, and the undermining of women and girls’ agency.”

To counter what she describes as “Conservative International”, Women Deliver is convening a global gender equality conference in April to enable like-minded organisations “to meet each other to strategise together”. 

“We are organising to push forward a more progressive agenda that really centres the autonomy, the rights to dignity for women and girls,” she said.

Salwan Daher added that the current “crisis of multilateralism doesn’t come from nowhere”.

“It has been exacerbated by the postures of the Trump administration, but really, it was brewing before. It was brewing because of double standards in the application of international law. The genocide in Palestine has really exposed the fault lines,” said Salwan Daher.

“We do not want a world without multilateralism. So now is the time to reimagine collectively what multilateral can look like. How do we make it people-centred? How do we make accountability at the root of everything, every process and every global space? How do we ensure the legal obligations of states?”

Abortion taboo

Pauline Fernandez, coordinator of the Philippines Safe Abortion Advocacy Network (PINSAN), said that despite her country having one of the harshest laws against abortion, there was growing recognition of the need to decriminalise abortion.

“Despite it being criminalised, abortion remains a widespread and urgent reality in the Philippines,” said Frenandez.

“Data shows that upwards of a million women undergo abortions annually, and because of abortion-related complications, up to three women die every day in the Philippines.”

Sustained organising about the importance of decriminalisation had seen PINSAN to her grow from 10 to 130 organisations.

Over 30,000 people have signed PINSAN’s petitionin support of decriminalisation, helped by a recent Netflix documentary on the subject by a famous local filmmaker.

Regular reviews

Dr Virginia Kamowa, regional and country manager at the Global Center for Health Diplomacy and Inclusion (CeHDI), which co-hosted the event, said that the Universal Periodic Review UPR) provides a lever to ensure better SRH services.

“The UPR is the only mechanism of UN that reviews every country on a regular cycle against the human rights obligations of the governments, and produces a public on-the-record government commitment,” explained Kamowa.

“More and more recommendations have been on health,” she said, adding that aroung 82% of health recommendations were accepted by the country being reviewed.

Improving maternal health involved many aspects of SRH, she noted.

Rwanda was reviewed last week, while the reviews of St Lucia, Namibia, Mozambique, Somalia, Seychelles, Sierra Leone and Eswatini are imminent.

“All 193 UN member states undergo a UPR. There’s a national report that is written by the government within the country, but also the UN bodies within the country that also do their own population and stakeholder research, civil society, NGOs and human rights institutions also compile their summary reports.

“During the process, other states ask questions and make recommendations to the country that is being reviewed, and the reviewed country can accept or not those recommendations, and then there is follow up in the next cycle of the UPR review.”

Image Credits: ©Gates Foundation/ Prashant Panjiar.

Guinea-Bissau Health Minister Quinhim Nanthote (right), with his director-general, Dr Armando Sifna.

A controversial trial to examine various impacts of the hepatitis B vaccine on newborn babies in Guinea-Bissau has been “suspended or cancelled”, the country’s Health Minister, Quinhim Nanthote, told a media briefing convened by the Africa Centres for Disease Control and Prevention (Africa CDC) on Thursday.

This is despite recent assertions by the US Health and Human Services (HHS) Department, which is funding the trial, that it was going ahead.

Nanthote initially told the briefing that his country’s ethics committee had not yet held a meeting about the trial, but later said that it “did not have the required technical resources” to approve the trial.

Nanthote, who addressed the briefing in military fatigues, was only appointed health minister on 29 November 2025, following a military coup three days earlier. He was not part of discussions about the trial, which has been proposed by the  Danish research group, Bandim Health Project.

According to Bandim’s trial protocol, dated 14 January, “the Guinea-Bissau Committee of Ethics approved the trial on 5 November, 2025, with approval number 036-CNES-INASA-2025”. However, this was before the military coup.

Global outrage

There has been global outrage over the ethics of the trial, which would only give half the 14,000 babies it aims to enrol a hepatitis B vaccination shortly after birth – despite clinical evidence that early vaccination is highly effective at preventing mother-to-child transmission of the virus, which is the leading global cause of liver disease.

Although babies in the country only start to get vaccinated against hepatitis B at six weeks,  around 11% of children in the country are already infected with hepatitis B by the age of 18 months,and the government has resolved to introduce vaccination at birth from 2027/8.

While Bandim says it will stop its trial before the national rollout, health experts assert that it is unethical to knowingly withhold a proven treatment from a baby born to a mother with hepatitis B (the trial is single-blinded, so researchers will know which babies get the vaccination and which get the placebo).

US involvement

The US Centers for Disease Control and Prevention (CDC) awarded Bandim a $1,6 million five-year grant to “assess the effects of neonatal Hepatitis B vaccination on early-life mortality, morbidity, and long-term developmental outcomes”, according to the US HHS federal register.

Dr Christine Stabell Benn, co-leader of Bandim, is an adviser to the US Advisory Committee on Immunization Practices (ACIP), which recently resolved to stop recommending hepatitis B vaccines to US newborns. 

HHS Secretary Robert F Kennedy Jr fired most of the ACIP members last year, replacing them with a committee dominated by vaccine critics.

For years, Stabell Benn, co-principal investigator of the Guinea-Bissau trial, has researched the “non-specific effects” (NSE) of vaccines. She and colleagues have conducted trials involving thousands of children in Guinea-Bissau and Denmark, and assert that all vaccines should also be tested for NSEs.

One of the research aims of their Guinea-Bissau trial is to investigate the effect of the vaccination “on neurodevelopment by five years of age”. This dovetails with Kennedy’s belief that the rise of autism is linked to childhood vaccinations.

“RFK Jr. has manipulated the [Guinea-Bissau] study to support his unsupportable, science-resistant beliefs about harms caused by the hepatitis B vaccine,” observed US paediatrician Dr Paul Offit, co-inventor of a rotavirus vaccine, on his Substack platform.

Role of Africa CDC

Africa CDC Director-General Dr Jean Kaseya

Africa CDC Director-General Dr Jean Kaseya said that African countries were in “total control” of clinical trials conducted in their countries.

However, Africa CDC has developed a 13-step guide to assist countries.

“I was talking to the minister [of Guinea-Bissau] who called me three days ago and clearly said, told me: ‘DG, I’m a new Minister. I’m still waiting for the two steps, the National Medicine Regulatory Authority and the National Ethics Committee, to come to brief me and to give me the recommendations. I’m also asking if Africa CDC can come and support us to see this protocol and all other documents, then I can make a decision based on this recommendation’,” Kaseya told the media briefing.

He also dismissed a report that unnamed HHS officials had made disparaging remarks about Africa CDC over its contention at a media briefing last week that the trial had been cancelled.

“We have our diplomatic relationship with the US. Yesterday, senior people from HHS were talking to senior people from Africa CDC, and I was briefed that they don’t know anything about any statement against Africa CDC,” said Kaseya, who said that his organisation has an “excellent relationship” with the US government.

Kaseya added that Africa CDC had decided not to involve itself in the bilateral Memorandums of Understanding that the US was negotiating with African governments under its “America First Global Health Strategy”.

However, he said that the implementation of the MOUs would be discussed at a meeting of health and finance ministers that he is convening on 13 February.

NCD WEF
As the World Economic Forum (WEF) met in Davos this week, a new WEF report on NCDs reflects the influences of powerful groups on disease priorities.

The World Economic Forum’s (WEF) latest report on acting early on noncommunicable diseases (NCDs) signals more than urgency. It signals a shift in what counts.

Beneath familiar calls for earlier action sits a quieter move: a re-ordering of NCD priorities themselves. Some diseases now sit firmly at the centre of the agenda. Others, no less prevalent or consequential, are absent or muted.

The clearest indicator is the report’s treatment of chronic kidney disease (CKD). CKD is presented, not as a downstream complication, but as a core NCD, positioned comfortably alongside cardiovascular disease, diabetes, cancer, and chronic respiratory disease. No extended justification is offered. Its inclusion is just assumed.

CKD’s elevation is overdue, but its inclusion in the WEF report also reveals how NCD categories solidify. Diseases move to the centre not only because of burden, but because they align with existing biomedical pathways, specialist care models, insurance logic, and pharmaceutical governance. 

Seen this way, the report is not simply about acting earlier. It is about which disease problems global health institutions are structurally prepared to organise around.

The politics of NCDs

NCDs have never been a neutral list. They are the product of political and institutional settlement. Inclusion brings visibility, financing, and organisational ownership. Exclusion does not erase a condition, but it shapes how seriously it is taken in policy, planning, and budgets. What this report suggests is that the settlement is shifting again, quietly rather than through open debate.

The contrast between what fits and what does not is striking. Oral health is absent altogether, despite affecting more people globally than all other NCDs combined. Dementia barely registers, even as it reshapes ageing societies and long-term care systems. 

Air pollution appears only as a generic risk factor, detached from its regulatory implications. Obesity and physical inactivity are acknowledged but they never organise the analysis. Mental health is present, but thinly so. Eye health and several other NCDs are missing entirely.

This is not ignorance. The WEF itself has published economic analyses making the case for investing in oral health. It is well aware of dementia, air pollution, and obesity as global challenges. The issue is not whether these conditions matter, it is whether they fit prevailing system architectures.

Institutional compromises

Debates around expanding the NCD frame, including the so-called 6×6 perspective, were never simply about adding conditions to a list. They exposed how the NCD framework hardened into an institutional compromise, privileging problems that are easier to govern, finance, and narrate. 

Oral health and others were excluded not because the evidence was weak, but because their inclusion would have unsettled that compromise.

What the WEF report suggests is that the frame is being adjusted again, but cautiously. Rather than opening outward to accommodate conditions that strain existing arrangements, it tightens inward around those that reinforce them.

 CKD aligns neatly with this logic. It can be framed as an extension of diabetes and hypertension. It lends itself to biomedical markers, specialist pathways, and pharmaceutical management. It fits insurance systems and performance frameworks. 

Crucially, it does not force difficult conversations about food systems, sugar, taxation, or commercial power. It can be absorbed without rewriting the rules.

Other conditions are less accommodating. Oral diseases pull sugar into view as a specific commercial determinant, not a vague lifestyle choice. They expose the fragility of private financing and fee-based care, and make inequality impossible to ignore. Dementia collapses the boundary between health and social care.

 Air pollution pushes responsibility far beyond the health sector. Climate-related exposures, including extreme heat, increasingly shape NCD risk and outcomes, yet remain difficult to absorb into disease-specific prevention frameworks, as they demand action across labour policy, urban design, housing, and climate governance. Obesity, if taken seriously, leads quickly to trade policy and regulation.

These are not marginal complications. They are precisely the kinds of questions that strain consensus and unsettle partnerships.

Inclusive understanding

This quiet consolidation sits alongside longer-standing efforts by groups such as the NCD Alliance to defend a broad and inclusive understanding of NCDs. That advocacy has helped keep multiple conditions visible in political commitments, even as institutional practice increasingly favours a narrower, more governable set of priorities.

The institutional setting matters. The WEF operates through public–private convening. Pharmaceutical companies, diagnostics firms, and health-technology actors are not peripheral to its health work; they are part of the room. This does not mean reports are written to serve corporate interests, but it does shape which narratives travel easily and which stall.

One contemporary signal reinforces this pattern. This week at the WEF in Davos, a global partnership was announced between Colgate-Palmolive (the leading global manufacturer of oral hygiene products) and the WHO Foundation. 

At a moment of tightening budgets at WHO, including the loss of dedicated oral-health staff, such arrangements are widely hoped to help stabilise institutional capacity and preserve visibility for conditions otherwise at risk of further marginalisation.

Analytically, they reflect the same logic at work: when conditions fall outside the core NCD architecture, they advance through parallel channels rather than through the centre of system reform.

The risk is subtle but real. The NCD discourse begins to tilt away from the conditions that most shape lived experience towards those that best fit institutional comfort. Authority shifts not because of burden or equity, but because of governability.

CKD did not move to the centre by chance. It arrived because it belongs to the version of NCDs that the global health sector currently finds easiest to manage. Other conditions remain outside, not because they matter less, but because they ask harder questions about responsibility, power, and what health systems are ultimately for.

That is what this report reveals. It is not primarily a story about acting early. It is a story about how carefully and quietly the boundaries of action are being redrawn.

Habib Benzian is Professor at the University of the Western Cape (Cape Town, South Africa), Noel Martin Visiting Chair at the University of Sydney’s Dental School; and a member of the Lancet Commission on Oral Health. He advises governments and international organisations on health policy and equity.

 

 

Image Credits: WEF.

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

The Gates Foundation and OpenAI announced a $50 million “pilot” on Wednesday to “advance AI capabilities for health” in Africa. Horizon 1000 promises “funding, technology, and technical support” to roll out AI solutions to 1,000 African primary healthcare clinics by 2028.

“AI is going to be a scientific marvel no matter what, but for it to be a societal marvel, we’ve got to figure out ways that we use this incredible technology to improve people’s lives,” said Sam Altman, CEO of OpenAI, in a media release.

“The goal is to make [health care] much higher quality, and if possible, twice as efficient as it is today – taking away the paperwork, organising resources so the patient knows what is available and when to come for their appointments,” Gates Foundation CEO Bill Gates told a session at the World Economic Forum (WEF) in Davos on Wednesday.

Starting with Rwanda 

The pilot will start in Rwanda, and later branch out to Kenya, South Africa and Nigeria, Gates added.

Rwanda is already exploring the use of AI to help health workers with disease diagnosis, relieve them of onerous administrative tasks, and model the trajectory of diseases.

Paula Ingabire, Rwanda’s Minister of Information, Communication and Technology and Innovation, told the WEF that her country has been working on technological solutions for its “pain points” for over two decades.

As a start, the country has rolled out internet access to around 97% of its population – a significant achievement in a country where most people live in rural areas.

It is currently building “some of the foundational digital infrastructure that is enabling and powering [technological] advancements,” said Ingabire.

One of Rwanda’s aims is to use AI to create “decision-support tools” for its 60,000-plus community health workers (CHW) who provide primary healthcare to communities across the country.

As around 70% of the cases CHW deal with every year are malaria, the country wants an AI tool to help them to improve diagnosis and to better anticipate when and where to expect malaria cases, said Ingabire.

Paula Ingabire, Rwanda’s Minister of Information, Communication and Technology (ICT) and Innovation.

Rwanda has already used a combination of drones and AI to address malaria – with the drones pinpointing and spraying mosquito breeding sites and AI helping with the prediction and modelling of the disease.

Two years ago, Rwanda set itself the goal of quadrupling its health workforce in four years – something it has already almost achieved.

“But they’re going to need these tools to support better care delivery. Some of the administrative tasks that they’ve been working on, we can use AI to do that, so they’re more focused on delivering better and targeted care to our people,” Ingabire said.

The government also wants to use AI to improve its demand forecasting for health commodities to prevent medicine stockouts.

“We started this digital transformation journey more than 15 years ago. We have a lot of data that we’re not using. Building national data intelligence platforms that help us is critical. Once we build these models, they need to be trained on our own data, they need to be context specific, and they need to come in to address real problems.”

Ingabire added that her country is also in conversation with the AI company Anthropic, which developed the large language model Claude, “to see how we can have an instant health intelligence platform that then feeds into the entire national health planning systems and allows us to allocate better resources”. 

AI-based TB screening

Global Fund CEO Peter Sands

Peter Sands, CEO of the Global Fund to Fight AIDS, Tuberculosis and Malaria, told the WEF that the fund has invested $170 million over the past four years in AI-based TB screening.

This is one of the largest single applications of AI and health, and it is delivering a “very significant impact”, he added.

One example of how the Fund has used AI-based TB screening is in refugee camps.

“There are well over a million Sudanese refugees in Chad, and we set up mobile clinics with the government of Chad to go into these refugee camps and do screening for TB,” said Sands. 

As there were no radiologists, “if you want the screening to be interpreted, there is no alternative [but AI]”, he added.

However, Sands warned that some “very basic problems” still need to be fixed to enable the rollout of AI-driven solutions – primarily that many African primary health care facilities lack internet connectivity, and some even lack power.

He also urged the use of AI to be “framed around problems needing solutions, as opposed to a whole bunch of tools needing a problem to fix” – akin to people “running around with a whole lot of hammers looking for nails”.

He added that tools are easier to develop than finding people “who can actually use them and make things happen”. 

Faster progress in LMICs than wealthy countries?

Gates Foundation CEO Bill Gates

Gates believes that there may be faster progress with the rollout of AI in healthcare in developing world health than the “rich world” because “the need is so great, and the governments are embracing this and making sure that it’s moving at full speed”.

“The $50 million commitment is just the beginning. I believe that people in Africa should have this ‘health advisor’ without having to pay anything for it. It should just be a basic capability available to them. 

“As you go into the health system, instead of filling out paperwork and redescribing everything, the AI that you’ve been talking to is summarising that… getting rid of the paperwork together.”

Sands also believes that low- and middle-income countries could adopt AI tools faster than developed economies, which are more regulated and where AI is more likely to take away jobs. 

“One of the reasons this may well take off faster in middle-income countries is because there won’t be the resistance from people who say: ‘This has taken my job’ and ‘I don’t want to change the way we do things’, because it’s compensating for the fact that those people don’t exist.”

Image Credits: Cecille Joan Avila / Partners In Health.

A new government report concedes that vehicles are the most prominent source of pollution within Delhi, and that the mandatory pollution-under-control (PUC) certificates are not a true representative of emissions.

DELHI – India’s Commission for Air Quality Management (CAQM) has identified the main sources of Delhi’s severe air pollution and admitted that there are critical gaps in current control measures, in response to a deadline set by the Supreme Court. 

The report, completed in a fortnight, synthesises findings from multiple research institutions to create the first unified assessment of what is polluting the capital. 

The Supreme Court-mandated report reveals that the city’s main air pollution sources are: transport (23%), secondary particulates (27%), and dust (15-27%). Winter PM2.5 levels are 35 times the World Health Organization (WHO) guidelines, despite decade-long efforts.

The report comes after the Supreme Court criticised CAQM on 2 January, for delays in identifying causes and finding long-term solutions to Delhi’s “worsening” air quality.

What sets this report apart from earlier studies is that it synthesises previous assessments to arrive at one unified set of numbers. The agency achieved this by bringing together researchers from government agencies, Indian Institutes of Technology, research institutes, NGOs and think-tanks.

The Chief Justice of India criticised the CAQM earlier this year, saying that it “appears to be in no hurry either to identify the causes or to find long-term solutions” to Delhi’s pollution.

The court added that the CAQM is obligated to bring domain experts together to arrive at a uniform and unanimous opinion on the causes of the “worsening” air quality.

Government concedes major gaps 

The CAQM’s report is also significant because it concedes several critical gaps in Delhi’s pollution control efforts. These range from conceding that PM2.5, or fine particulate matter pollution, is the “worst” pollutant to accepting that the pollution-under-control (PUC) certificates don’t check all key pollutants emitted by vehicles.

The panel included experts from government institutions as well as independent research organisations, including the Centre for Study of Science, Technology and Policy (CSTEP), Council on Energy, Environment and Water (CEEW), Urban Emission, Centre for Science and Environment (CSE) and The Energy and Resources Institute (TERI). 

The report has released two important data sets. The first shows that there has been a decline since 2016 in the annual average level of PM2.5. But the trendline (in blue in the chart below) has been almost flat since 2019, the year that the Indian government launched the National Clean Air Programme (NCAP).

Delhi’s PM2.5 air pollution has hovered around 100 micrograms per cubic metre for the last seven years, which is 2.5 times India’s safe standard but 20 times the WHO’s safe guidelines.

Source: Based on data from CAQM

Main sources of Delhi’s air pollution

Delhi’s air pollution in winter and summer is starkly different, with winter pollution being more than twice as severe.

The largest contributor to Delhi’s winter PM2.5 pollution is secondary particulate matter (27%), tiny particles formed in the air from gaseous emissions from vehicles, industries, and biomass burning.

Among primary sources, transport vehicles contribute 23% while biomass burning, including burning solid fuels for cooking and warmth and crop residue burning, adds 20%. Dust from roads, construction, and demolition accounts for 15%, and industrial emissions contribute 9%.

In summer, dust becomes the dominant source, causing 27% of PM2.5 levels, driven by dry conditions and construction activity. Transport contributes 19%, secondary particulate matter causes 17%, and industrial emissions rise to 14%. Biomass burning drops to 12% during this period.

Source: CAQM, Delhi

Delhi’s average winter PM2.5 concentration is 178 micrograms/m³, which is more than 35 times the WHO safe guideline of 5, and over four times India’s national standard of 40. Summer levels average 73, which is still nearly 15 times the WHO guideline and almost double the Indian standard. Data is based on 2021-2025 measurements.

However, CAQM says that the number of days where pollution was below the daily national standard of 60 micrograms has increased from 97 days in 2018 to 156 in 2025.

Why is transport so high?

The report points out that transport “repeatedly emerges as the most prominent pollution source within Delhi”. The transport source category includes off and on-road vehicles; petrol, diesel and CNG-powered vehicles.

There are several sources and reasons for vehicular pollution being so high:

  • Older fuel standards: Bharat Stage (BS) 4, 3, 2, 1 and pre-BS vehicles are more polluting than the latest, BS 6 standard.
  • Older vehicles: Particularly those operating beyond their regulatory lifespan of 10 or 15 years – for petrol and diesel respectively – are more polluting due to engine deterioration and compromised emission control performance.
  • Fuel type: Diesel vehicles are a major source of particulate matter and oxides of nitrogen and sulphur, whereas CNG vehicles predominantly emit oxides of nitrogen.
  • Traffic congestion: Pollution is determined not just by technology but also by driving conditions. Congested and slow-moving traffic leads to inefficient combustion, resulting in higher emissions per vehicle, whereas operation at optimal speeds enables more efficient combustion and lower emission rates.

Government admits critical gaps 

Significantly, the report concedes several gaps in controlling pollution. Presenting these gaps in a report for the Supreme Court is important because these have rarely been acknowledged at such a high level.

First, the report admits the current pollution checks or PUC certificates are “not a true representative of emissions” as they don’t measure particulate matter pollution – although this has been cited repeatedly by the Delhi local government as a measure that controls pollution.

Second, it accepts that PM2.5 is the most prominent pollutant that determines Delhi’s air quality index (AQI). This is in sharp contrast to the NCAP, which prioritises the reduction of PM10, not the more lethal PM2.5. Delhi government also has a push to reduce PM10, primarily dust, through the use of hundreds of expensive water sprinklers.

Third, the report says that data on the sources of pollution in Delhi’s larger neighbourhood (NCR) is sparse, so the report’s meta-analysis is taken as indicative.

Fourth, the supply of grid electricity across Delhi’s neighbourhood is “unreliable” which is why the use of diesel generators (DG) has increased substantially. It calls older or poorly maintained DGs “super-emitters” and warns that they result in direct, ground-level exposure to emissions.

Around 6 to 11% of Delhi’s air pollution is caused by “other” sources. These include cremations where wood is used, hotels and restaurants which use solid fuels like wood and coal, aircraft emissions during taxiing, landing and take-off, and brick kilns in and around Delhi.

Depending on the season, they are equally dangerous because they create local hotspots close to residential areas. These are a significant challenge because the CAQM says these are highly sensitive to enforcement.

What’s the plan to cut Delhi’s pollution?

The CAQM has asked four institutes, three of them government-backed, to develop a new emission inventory – a database of how much pollution is being pumped into the air and from which sources.

This study will be led by the Automotive Research Association of India (ARAI), which may raise some questions about a conflict of interest. While the association is under the government’s administrative control, many ARAI officials and members are from major vehicle manufacturers. Given that vehicles are a significant source of pollution, this could compromise ARAI’s ability to assess vehicular pollution. 

The other three institutes are IIT-Delhi, the Indian Institute of Tropical Meteorology (IITM, Pune), and The Energy and Resources Institute (TERI).

Air pollution beyond Delhi

This new push by the Supreme Court to improve Delhi’s air quality could have lessons for the wider area of north India or the Indo-Gangetic Plains (IGP), which the CAQM calls an emissions hotspot. This is 18% of India’s landmass, home to 40% of the country’s 1.4 billion population, and accounts for 35% of the emissions.

A still wider picture comes from the World Bank’s new report, A Breath of Change: Solutions for Cleaner Air in the Indo-Gangetic Plains and Himalayan Foothills. 

Almost a billion people across five countries – Bangladesh, Bhutan, India, Nepal, and Pakistan – live in this area, and around one million people die prematurely every year from polluted air. 

The World Bank calls for regional cooperation, which is easier said than done in one of the world’s most geopolitically sensitive neighbourhoods.

India’s capital is roughly in the centre of this region. Fixing Delhi’s air can provide a template and impetus to go big.

Image Credits: Chetan Bhattacharji.

IGWG co-chair Matthew Harpur and WHO Assistant Secretary General Dr Chikwe Ihekweazu.

The World Health Organization (WHO) negotiations on the world’s first Pathogen Access and Benefit Sharing (PABS) system resumed in Geneva on Tuesday – with only two more weeks of formal negotiations left before the May deadline.

Symbolically, this week’s talks resumed on the first anniversary of US President Donald Trump’s announcement that his country would no longer be part of the WHO, and amid a flurry of US bilateral agreements with African countries that exchange health aid for access to pathogen information – posing a direct challenge to the PABS system being negotiated.

Over the next three days, WHO member states will hold a series of informal and formal talks focusing mainly on the scope and objectives of the PABS system, use of terms and governance issues.

Dr Chikwe Ihekweazu, WHO Assistant Director-General for Health Emergencies, told the meeting at its start on Tuesday that the negotiations are a priority for WHO.

“In an ever-divided world, we are guardians of public health, and we need to protect it from politicisation,” said Ihekweazu.

“The future of multilateralism depends on the very discussions you have in this room over the next few months. Let the determination that led you to adopting the [Pandemic] Agreement see you through this week successfully.”

Crunch time

While acknowledging that divergent views were still evident in the informal meetings held over the past few weeks, “I do see a lot of positive movement that I think we can be very proud of”, he added.

“It’s no secret that crunch time has started, and before we know it, the [World Health Assembly] will be upon us. After this week concludes, you will be left with around two weeks of formal meetings. Please use every minute and use the informal period to iron out the differences that persist and come closer together on landing zones.”

A PABS system would set out how to share pathogens and their genetic information, along with any benefits that may arise from their use, including the development of vaccines and medicines. 

Meanwhile, the US has signed 15 MOUs have been signed with African countries – the latest being with Malawi on 14 January. The agreements provide opportunities for US companies to provide logistics, data, and supply-chain support and several have been concluded alongside trade agreements.

The MOUs are the precursor to five-year grants that involve a rapid transfer of responsibility for domestic health programmes from the US to donor countries from year two of the agreement.