It is often said that those who fail to learn from history are doomed to repeat it.

So what, if anything, can we learn from the history of health? In this brand new season of the Global Health Matters podcast, host Garry Aslanyan takes a step back in time to look at why “history matters” and to discuss the value and merits of understanding global health history and the evolution of global health, particularly concerning the establishment of the World Health Organization (WHO), which this year celebrates its 75th anniversary.

“All institutions have long histories,” guest Sanjoy Bhattacharya, head of the School of History and Professor of Medical and Global Health History at the University of Leeds in the UK, told Aslanyan.” And those long histories have determined negotiations between complex partnerships, complex organisations, and how we operate today is deeply determined by those long-term negotiations, which is historical. So history matters.”

Speaking on the history of global health in terms of colonialism and colonial powers, Professor of Global Development Studies and Global Health at the University of Toronto in Canada, Anne-Emanuelle Birn, said, “In the 19th century, the arena that has evolved or erupted, transformed into global health history, began in a very particular context, that of imperialism, particularly European, but also North American imperialism and the growth of the colonial enterprise.

“Health and medicine played a very important role, so one of the earliest precursors to global health history, or global health, was colonial medicine.”

By the middle of the 20th century, after two world wars ravaged the world, there was renewed hope which saw the formation of several new international cooperation organization, such as the United Nations. In this arena, the World Health Organization was founded in April 1948, aiming to work worldwide to promote health and coordinate responses to health emergencies.

“You have this transition, and it really takes off after the founding of the World Health Organization, this idea of international health, health between countries, through sometimes collective decision-making but also very much influenced by the world order, in that case, the Cold War,” Birn said.

“For me, WHO is not just Geneva,” Bhattacharya said. “if you look at a bottom-up history of WHO, where you center the regional offices, I would submit that you actually get a much more decolonised and democratic history of international and global health than you would if you looked at Geneva and say that everything that is happening in global or international health is happening because of things that are happening in Geneva.”

Taking a look at a very recent example of COVID-19, Birn points out that as much as coordinated international efforts can combat the quick spread of disease and introduce appropriate measures, at the same time, every country is in its own unique situation based on cultural and social factors.

“With the COVID-19 pandemic, there was an expectation in certain quarters that history would help to address, resolve, shed light on the course of the pandemic,” Birn said. “There’s no way historical perspectives can resolve social, political, and other forms of tensions that the response to COVID-19 continues to engender, arguably. History can’t predict or liberate, and every pandemic has occurred in particular social, political, and cultural configurations. So there’s no recipe, right? The expectation was that history would provide a recipe.”

“There are multiple historical narratives about any aspect of global pandemics,” Bhattacharya added. “So if you’re saying was COVID influenced by any historical narratives, then the problem then became that there wasn’t one historical narrative.”

Looking into the past can sometimes provide the lessons or answers we seek, but as Bhattacharya pointed out, it is essential to know which or whose history one is learning. “History matters, but we must always ask which history matters because there are multiple histories.”

This is part I of a two-part series. 

Image Credits: Global Health Matters Podcast via TDR.

Member states attending the World Health Assembly’s high-level opening on Sunday, 21 May in Geneva.

The World Health Assembly opened its annual meeting of member states Sunday on a celebratory note marking the 75th anniversary of the World Health Organization’s foundation in 1948.

Eradicating smallpox, eliminating polio in most countries worldwide, and dramatic reductions in deaths from once-deadly childhood diseases preventable by clean water, basic medicines and vaccines are among a few of the historic accomplishments the Organization will be celebrating as this year’s 76th WHA session begins, said WHO’s Director General Dr Tedros Adhanom Ghebreyesus in opening remarks at the WHA.   

“Smallpox is history and polio is on the brink. And epidemics of malaria, HIV and tuberculosis have all been pushed back,” said Dr Tedros. 

Thanks to the Framework Convention on Tobacco Control, smoking rates have declined in dozens of countries worldwide, with strict policies on tobacco advertising and taxes on tobacco products.  

He was speaking Sunday at a WHA preview event at the Geneva Graduate Institute’s Global Health Center, just before the official WHA curtain-raiser; the latter featured a lineup of high-level figures from around the world, including India’s Prime Minister Narendra Modi and former New Zealand Prime Minister Jacinda Ardern. 

Pandemic treaty negotiations set against regional conflicts

The number of people living in zones of combined conflict and health emergencies has doubled since 2015 – Kate Dodson, UN Foundation

But against those successes, this year’s WHA is taking place against the background of complex, ongoing negotiations over an ambitious new pandemic treaty and, in parallel, talks over revisions to the 2005 International Health Regulations that aim to supplement and replace archaic rules on international emergency response. 

The WHA also is taking place in a second year of war between Russia and the Ukraine – whose bitter dispute was the subject of competing WHA resolutions last year – and which will likely again surface in debates by the global health body this year.  

And the Ukraine-Russia war is only one of multiple conflicts destroying lives and global health. As this year’s WHA considers a new “Health for Peace Initiative”, some 39 million people are – or almost one in 20 of the world’s population – living in fragile and complex settings that combine conflict with health emergencies. 

“That’s an increase of 25% since just last year, and double since 2015,” noted Kate Dodson, vice president for global health at the United Nations Foundation, a co-sponsor of the Graduate School WHA opener.   

And while this week’s WHA session is set to approve update guidance to countries on “best buys” for reducing non-communicable diseases, NCD disease rates are soaring worldwide, with heart disease having increased by 60% in the last 30 years, according to data published by the World Heart Summit, also convening this weekend in Geneva.  

Meanwhile, the WHO remains financially challenged. For the first time ever, this year’s WHA is supposed to approve stepped up rates of annual contributions by member states to the global health organization. 

It will also debate a January Executive Board recommendation to establish a “replenishment fund” for voluntary contributions by donors and member states that could be used in a more flexible way by the Organization than “earmarked” donations that make up the bulk of its budget today. 

Challenges moving far beyond the health sector  

Non-communicable diseases now account for 70% of deaths globally – WHO Director General Dr Tedros Adhanom Ghebreyesus at the opening of the 76th WHA.

Overall, as it enters its 76th year of existence, the Organization is increasingly challenged by the need to respond coherently to an increasingly broad and complex portfolio of  emerging disease threats – over which it often has little influence or control. 

Those include obesity, heart disease and hypertension stimulated by sedentary lifestyles and fast food diets; antimicrobial resistance from misuse and overuse of antibiotics in both the human and  animal health sector; the climate crisis and air pollution; and as COVID-19 demonstrated to the world – vast disparities in access to health care including vital medicines and vaccines. 

“Non communicable diseases now account for some 70% of deaths globally,” noted Tedros in his opening WHA address. 

“Antimicrobial resistance threatens to unwind centuries of medical progress.  Vast disparities in access to health resources exist between and within countries and communities. And the existential threat of climate change is jeopardizing the very habitability of our planet.

“WHO has grown enormously but our resources have not,” Tedros added. “There is the challenge of being a technical scientific organization in a political, and increasingly politicized, environment.”

“These are daunting and complex challenges. We will not solve them at the World Health Assembly and we will not solve them in our lifetimes, but we’re building a path that our children and grandchildren will walk down and that they will continue to build,” Tedros said. 

“The challenges of today are very different to those we faced in 1948. But the vision is the same.”  

1969 International Health Regulations only covered four diseases

In 1969 the International Health Regulations only covered four disease – former WHO official David Heymann (on left) speaking at WHO preview event at the Geneva Graduate Institute

“When the [WHO] International Health Regulations were developed back in 1969, their goal was really to stop disease at borders,” pointed out David Heymann, a former high-ranking WHO official, at the Geneva Graduate Institute’s WHA preview event Sunday morning. 

“If a country reported one in four infections, cholera, yellow fever, plague or smallpox, then countries that were receiving passengers from those countries could request a vaccination certificate.  There were pre-determined measures to stop disease transmission, and at that time, WHO was the exclusive owner of much of the information because countries reported to WHO, WHO did a risk assessment, and provided its recommendations.”

While the IHR finally  underwent a major update in 2005, greatly broadening the scope of what was to be reported –  and empowering WHO to declare a “Public Health Emergency of International Concern (PHEIC),” the regulations have failed to keep up with the pace of change in the real world, he pointed out. 

The biggest failure, he contends, was in “the most important part of the IHR, which was the requirement of countries to establish core capacity in public health to be able to detect, respond and prevent national disease spread and death, and eventually prevent international spread by this rapid reaction.”

In terms of risk assessments as well, as the digital transformation accelerated the spread of information, WHO was no longer the exclusive arbiter of risks from pathogens that appeared.

“As we saw in the COVID pandemic, countries really preferred doing their own risk assessments. They had access to data which they had never had before – all respectable medical journals were publishing peer reviewed information in front of their paywall. So any government advisory group could get that and could make recommendations to their own government as to what to do. 

As a result, WHO lost its authoritative position in making recommendations, countries devised their own policies, and what ensued was “confusion, utter confusion” over global response, Heymann contended. “The [IHR] regulations to me, they’re really a vestige of the past.”

Negotiations over pandemic accord will be on sidelines of formal WHA    

Gian Luca Burci, former WHO chief legal counsel describes the workings of the World Health Assembly – and what to expect at this session.

This year’s WHA is set against the backdrop of ongoing negotiations over IHR revisions as well as the development of a new pandemic accord. 

Both are mired in controversial debates by member states over language on reporting outbreaks- including proposals for requiring countries to report emerging pathogen threats within hours. With respect to the pandemic accord, while all countries have paid lip service to the need to ensure more equitable distribution of drugs and vaccines in the next pandemic – they are at odds about draft language that would commit them, in advance, to set aside of fixed quantities of health tools for developing nations. 

Insofar as those negotiations are only due to conclude by May 2024, the most meaningful talks are likely to be in the corridors and on the sidelines of the WHA – rather than in the formal chambers of the meeting, being held at Geneva’s UN headquarters, said Gian Luca Burci, former chief WHO legal counsel at Sunday’s Graduate Institute session.  

“For [WHA] action, there is nothing specific on the IHR, Burci observed. With regards to the pandemic accord, the only main formal item explicitly on the agenda is the potential treaty’s cost.”  

“But there will be a Secretariat Briefing on the negotiations, and I’m sure there will be a lot of discussions, a lot of side conversations among delegates looking to break some of the deadlocks, and so forth.”

Meanwhile, WHO continues to move ahead with voluntary initiatives aimed at improving outbreak detection and response. For example, just ahead of the WHA’s opening, WHO announced the launch of a new International Pathogen Surveillance Network, that aims to detect and report infectious disease threats in real time, making better use of digital and genomic tools that many countries still lack.    

The new network represents an ambitious effort to fill a critical gap in WHO’s existing system of disease outbreak alerts – which can right now be delayed by weeks or even months if countries resist disclosure. But without revisions to the IHR, such networks will remain purely voluntary. So the key question, as always remains: will all countries join, collaborate and cooperate  – and who will support the improved capacity of low income countries for detecting and reporting new threats? 

climate emissions
Fossil fuel combustion is a leadng source of global warming as well as of health harmful air pollution emissions.

The World Health Organization (WHO) has called for focused  action to address global warming and climate change to promote health outcomes. Recommendations include concerted efforts to reduce carbon emissions, build climate-resilient and sustainable health systems and protect health from the impacts of climate change.  

There is also a decline in the treatment coverage for tuberculosis between 2019 and 2021, and a stall in the world’s progress to tackle non-communicable diseases (NCDs) like hypertension and adult obesity.

“Climate and Health” is featured as a separate chapter in the latest edition of the World Health Statistics Report, published by the WHO on Friday. This underlines its importance as a major driver of   health outcomes in coming years, WHO officials said. 

The 131-page annual compilation of health statistics, while providing a birds-eye view on the progress made on global health metrics, also highlights how the world is  not on track to achieve the targets set out in the Sustainable Development Goals (SDGs) 2030. 

“The world is off track to reach the sustainable development goals,” said Dr Samira Asma, assistant director-general for data, analytics and delivery for impact at the WHO during a press briefing on Thursday. “Unless we pick up the pace, we risk losing countless lives that could have been saved, as well as failing to improve the quality of life for all”. 

Spotlight on climate change

“For the first time, we have a dedicated section on climate change, recognizing its crucial role in shaping the global landscape,” Asma said, underlining the role climate plays in global health. 

The global average temperature during 2021 was around 1.20°C higher than levels observed during the pre-industrial years. The report added that it’s unlikely the world will be able to limit the rise in average temperature to the 1.5°C level agreed in the 2015-Paris Agreement, so as to avoid  “irreversible and catastrophic changes to our natural and human systems”. 

“In order to stay within the 1.5˚C global warming limit set out in the 2015 Paris climate agreement, the world will need to drastically reduce emissions through large-scale transformation across social and economic systems,” the report emphasized. 

WHO’s spotlight on climate change and its connection to health comes at the heels of the Annual to Decadal Climate update released by the World Meteorological Organization (WMO) on Wednesday. The WMO report stated that the world is likely to breach the 1.5°C limit set by the Paris Agreement  before 2027 – although if drastic mitigation measures were taken now they could still bring temperatures down again later.

Apart  urgent measures to reduce carbon emissions, countries should also concentrate on building climate-resilient and environmentally sustainable health systems to mitigate the effects of climate change on health. 

“At the global level, the health sector generates 4-5% of the global greenhouse gas emissions. Adopting sustainable practices brings benefits like improved accessibility, reliable services, and lower costs,” Dr Haidong Wang, the WHO unit head of monitoring, forecasting & inequalities, said. “Climate change has challenges to countries already dealing with non-communicable disease burdens. It may also lead to resurgence of infectious diseases”.

Infectious diseases and NCDs

The report revealed that in the past few years, the progress made by the world in combating infectious diseases like TB, HIV and malaria, and NCDs, have been reversed. 

Around 10.6 million people were diagnosed with TB in 2021, which is a 4.5% increase in numbers when compared with 2020. The global TB incidence rate increased by 3.6% between 2020 and 2021, reversing the progress made in the past two decades.

“Tuberculosis treatment coverage dropped from 69% in 2019 to 61% in 2021,” Wang pointed out. 

The situation around NCDs are equally grim.

NCD burden
Probability of dying from the four major NCDs (ages 30–69 years), projection versus SDG
target, WHO regions and global, 2000–2048.

If targeted efforts are not taken by countries, the objectives set out in the SDGs around tackling NCDs will remain unachieved.

“The share of deaths caused annually by NCDs has grown to nearly three quarters of all deaths and, if the trend continues, is projected to reach about 86% globally by WHO’s 100th anniversary in 2048,” the report cautions. “The United Nations projects that total annual deaths will reach nearly 90 million globally in 2048; consequently, 77 million of these will be NCD deaths – a nearly 90% increase in absolute numbers over 2019”.

COVID-19 pandemic: A medley of crises 

It is known that the COVID-19 pandemic caused unprecedented damage to health systems across the world. Not only did it kill millions of lives, it also caused considerable backsliding in decades-long efforts taken to address diseases like tuberculosis and HIV, and even changed the pattern of care-seeking across the world. 

“So the COVID-19 pandemic wasn’t just a health emergency, it was also a statistical crisis across the world,” Dr Dr Stephen MacFeely, WHOs director of data and analytics said. He added that several countries suspended longstanding surveys due to pandemic-related restrictions, making it impossible to acquire real data on issues like population and housing. 

“This shock interrupted the flow of data from already weak and fragile data systems.”

Emphasizing on the need to have robust, disaggregated, good quality data for monitoring and surveillance purposes, MacFeely said  that  WHO will be launching a “Data Dot Portal”, as part of the agency’s World Health Data Hub project, to serve as a “one-stop shop for health data”.  

The portal will be launching at the end of next week, as curtains fall on the 76th World Health Assembly, after being in development for nearly four years.

Image Credits: Chris LeBoutillier, World Health Organization.

Last year’s WHA late on the Saturday night, as Committee A struggled to reach agreement.

Much of this year’s WHA agenda, being held in Geneva between 21 and 30 May, should be preoccupied with pandemic preparedness and the WHO’s budget.  But there are some obscure items for anti-rights conservatives to latch onto if they want to derail discussion – and there is growing appetite for such disruptions throughout all UN agencies.

While officially, this year’s WHA is supposed to focus on a wide range of policy issues around the three pillars of WHO’s “Three Billion” strategy, which include emergencies and pandemics, non-communicable diseases and healthier populations, a few hidden minefields scattered in the agenda threaten to create unexpected flashpoints which could divert attention from the substance of the meeting. 

They include, once again, language around sexual health, but also as well as concerns about the place of states’ sovereign rights in the pandemic treaty, an initiative on a new WHO replenishment fund, as well as the perennial debates around the demand by Taiwan to be reinstated as a WHA observer, and the status of health in the Occupied Palestinian territories. What are the potential red-herring flashpoints lurking in the shadows of a dry and detailed agenda?  Here´s a brief review of the landscape:

Anti-rights red flags?

At last year´s World Health Assembly (WHA), an unexpected and protracted standoff over references to “sexuality”, “sexual orientation” and “men who have sex with men” in a technical guideline on HIV and hepatitis – pushed member states into an overnight session, delaying the close of the entire event.  

Last year, the Eastern Mediterranean Region (EMRO), supported by key North African countries, led the charge, with Saudi Arabia, Egypt and Nigeria vociferous in their condemnation of behaviours they deemed antithetical to their cultures. This forced talks late into the night and, finally, an unprecedented vote on the vexatious guide after numerous compromise clauses failed.

The Saudi delegate in a heated WHA debate over sexual rights and terminology.

If the conservatives are scanning assembly documents for men having sex with men, they’re unlikely to find any references. But if they are intent on looking for polarising needles in the agenda haystack, some might take issue with the report on the Global Strategy for Women’s, Children’s and Adolescents’ Health. This refers to the WHO’s updated handbook on family planning, which contains references to post-abortion care and gender identity. 

These are red flags for the right-wing UN coalition of member states, Group of Friends of the Family, founded by Egypt, Belarus and Qatar to advocate for the “natural family” that is becoming more vocal and more closely aligned with US rightwing Christian groups through annual World Congress of Families gatherings.

Multilateralism under fire

This year’s WHA takes place in an even tougher environment. Russia’s ongoing war in Ukraine has polarised the international community, compounding the economic struggles wrought by three pandemic years.

“The multilateral system is under greater strain than at any time since the creation of the United Nations,” UN Secretary-General Antonio Guterres warned in an address to the Security Council last month. 

“We are witnessing a deepening climate crisis, soaring inequalities, a rising threat from terrorism, a global pushback against human rights and gender equality, and the unregulated development of dangerous technologies,” he added.  

“All these global challenges can only be solved through respect for international law, adherence to global commitments, and the adoption of appropriate frameworks of multilateral governance.”

Heightened US-China tensions may well be inflamed by the large presence of Taiwan at this year’s WHA. The US appeal for it to be reinstated as an observer has been followed by a formal request from Belize for this to be included on the agenda.

The health of Palestinians, with an unprecedented rise of Israeli settler violence accounting for 25% of casualties, is also a geopolitical flashpoint.

National sovereignty and pandemic response

Much of this year’s WHA, themed “Health For All: 75 years of improving public health”, will be around measures to counter the next pandemic – particularly universal health care and health and how to increase WHO’s finances. 

The assembly will hear and comment on progress made on two pandemic-related processes: one to amend the International Health Regulations (IHR) to make them fit for the next pandemic and the other, to draw up a pandemic accord. But both negotiations are ongoing with a deadline of next year’s WHA, so it is unlikely that conflicts will climax at this session. 

However, concerns about member states’ sovereignty are likely to be expressed, something that Russia and China have stressed in previous discussions.

Meanwhile, misinformation continues to churn outside of the WHA from those who opposed COVID-19 vaccines and lockdowns who claim that the pandemic accord will give WHO superpowers, and could lead to international “vaccine passports”.

Anti-vaxxer and US presidential hopeful Robert F Kennedy and his organisation, Children’s Health Defense, are key sources of this misinformation and have organised global protests aimed at urging countries to exit the WHO on Saturday 20 May, the day before the WHA opens.

WHO finances in the spotlight

Members of the WHO Working Group on Sustainable Finance hammer out an agreement on increasing member state contributions this week, with Germany’s Björn Kümmel on far left.

As with last year, moves to increase the WHO’s budget ceiling are also likely to be a focus of animated discussion. Member states are supposed to be increasing their assessed contributions in line with a resolution passed last year. 

The 2024/ 25 proposed budget is therefore based on the portion of members’ contributions being raised from a dismal 12% of the budget to 20%, which the WHA budget document on the budget describes as “marking a historic move towards a more empowered and independent WHO”.

During the Executive Board discussion in January on increasing WHO contributions, the Africa region expressed the expectation that WHO would channel far more resources to country and regional offices – something that the WHO has tried to do and reports that country allocation had increased from 39% in the 2018/19 to 50% in the proposed 2024/ 25 budget.

The Agile Member States Task Group on Strengthening WHO’s Budgetary, Programmatic and Financing Governance has worked hard to find a way to stabilise WHO income, making it less dependent on donors and also more efficient.

Replenishment Fund

The assembly also will discuss a proposal from the WHO’s Executive Committee for the establishment of a replenishment fund.   

Most member states accept that the WHO is underfunded and over-reliant on donors’ conditional grants, slanting the work of the body. While a replenishment fund, effectively, also involves recruiting more in voluntary donations, the process is public and therefore potentially more transparent – similar to the periodic replenishment drives conducted by organisations such as The Global Fund and Gavi, the Vaccine Alliance.  Also, typically such funds are not designated for specific donor projects – but able to be used flexibly by the organisation involved. 

Ahead of the January Executive Board meeting, the WHO’s Programme, Budget and Administration Committee (PBAC) “acknowledged WHO’s need for more flexible, predictable and sustainable financing and considered that a replenishment mechanism provided a possible solution, especially for chronically underfunded areas of the organization’s programme budget”.

Meanwhile, a fascinating recent analysis of all WHA resolutions between 1948 and 2021  was recently published in the BMJ.

It notes: “While the WHO has been criticised for its siloed approach to address global health issues, the analysis suggests that this approach is not the collective will of the WHA but may relate to the way the WHO has been increasingly funded through earmarked voluntary contributions to specific programmes.”

Whatever decisions are taken, the attention of the international global health sector will be in Geneva over the next 10 days.

Image Credits: Germany's UN Mission in Geneva .

WHO member states discuss new pandemic convention or treaty in July 2022.

Civil society is unlikely to be included in the World Health Organization (WHO)’s pandemic accord negotiations and should focus on making an impact on its content, according to a  European Union official.

“I don’t see these rules.. changing very easily at this stage. So I would concentrate efforts in working on the substance more than on the process,” Americo Zampetti, a senior leader of the delegation of the EU at the UN, told a webinar convened by the Geneva Global Health Hub (G2H2) on Wednesday.

While the EU would be “quite content” with civil society being more active in the discussion, “some other partners are not similarly keen in being open and transparent and making the best use of civil society contribution”, he added. 

“Civil society is particularly apt at advocating so I would concentrate on advocating on substance more than on process because I see the process as basically gone,” he advised.

Americo Zampetti

However, the EU would “make a very strong case” for civil society participation in the institutional machinery leading to the adoption of the agreement, and “we trust that civil society will be a very active partner in implementing any future agreement”, he added.

Margot Nauleau from Save the Children warned that governments would need to work with the people to implement new pandemic obligations.

“This must start by building trust and legitimacy in the policy process because the absence of transparency and engagement will lead to misinformation and confusion,” said Nauleau.

“The negotiations on the pandemic code and the International Health Regulations are becoming more and more exclusive of civil society,” she added. “We no longer have access to the drafting group and there is no transparency on the textual proposals that are made by member states.”

This runs counter to the WHO Constitution and the Sustainable Development Goals, she added.

To rectify this, Save the Children has three recommendations to the WHO. The first involves more civil society involvement in the negotiation and drafting by, for example, enabling them access to “all relevant documentation, including the draft, and intervene in a timely and unrestricted way during the plenary and the working group sessions of the negotiations”.

The second recommendation is to include civil society in treaty decision-making bodies, as the Framework Convention on Climate Change does.

The third involves civil society inclusion in the “monitoring and compliance mechanisms of these instruments”, as is the case for the Nagoya Protocol.

Environment and tobacco control

Yves Ladar, Permanent Representative of Earth Justice to the UN in Geneva, said that civil society had been integrally involved in a number of key environmental agreements and brought a lot of expertise to these.

One of these was Aarhus Convention, signed in 1998, which “provides access to access to information, effective public participation and access to justice in environmental matters”, said Ladar. 

Patricia Lambert

Patricia Lambert from the Campaign for Tobacco-Free Kids, was part of negotiations for the Framework Convention on Tobacco Control as legal adviser to South Africa.

Civil society fought hard to be included in the FCTC negotiations, and one of the clauses of the Convention notes that “participation of civil society is essential” in achieving its objectives, said Lambert, advising groups to “organise, organise, organise”.

“I’m very discomforted to hear that, as far as the process goes, civil society has largely been left out,” said Lambert. “What is working against you that was not present at the time of the FCTC negotiations [adopted 23 years go], is the hardening of attitudes in certain governments to civil society and to civil society participation.”

 The HIV pandemic has affected over 2.3 million people in the World Health Organization’s (WHO) European Region, with nearly 300 new diagnoses made daily in 2021. The COVID-19 pandemic and geopolitical turbulences in the region impacted the course of the HIV pandemic and the response, displacing populations, and disrupting access to care and HIV testing.

Today, living with HIV is no longer a reason for despair and the management of HIV is well codified. As there is no cure, people living with HIV undertake life-long treatment that allows them to have healthy and long lives. The effectiveness of treatment is indisputable but the estimated treatment cost per person per year remains high. In Spain, it is estimated to be €11,638, while in Germany it soars to around €32,100. In France, the cost reaches €14,821, and in Italy, it amounts to €6,300.

While the introduction of pre-exposure prophylaxis (PrEP) in 2012 was a breakthrough in HIV prevention in Europe and globally, the burden of HIV continues to fall disproportionately in certain regions, like eastern Europe, as well as on vulnerable populations that include migrants, sex workers, people who use drugs and men who have sex with men. These disparities are felt in various aspects of HIV prevention and treatment, including limited access to testing and inadequate availability and affordability of prevention tools like PrEP.

Significant economic and human rights impact

WHO Europe: HIV in Europe 2021

Although the incidence of HIV in the region may not be as alarming as in other parts of the world, its impact is significant, not only on European economies but also on the human rights of its marginalised populations.

Within this context, immunisation is a crucial means of safeguarding public health, reducing morbidity and mortality. Additionally, it delivers advantages for the social and economic fabric of nations and helps alleviate the burden on healthcare systems.

Despite the disruption caused by COVID-19 in recent years, European scientists have rallied together in the pursuit of an effective HIV vaccine, conducting several early-phase trials with the backing of funding from Horizon 2020. These trials use original technologies often not developed elsewhere. However, plans and funds to ensure their continuity are urgently required, especially given the need for larger trials to achieve conclusive results.

So, why should Europe invest in the search for an HIV vaccine? First, an HIV vaccine would naturally help control the pandemic on the continent, not only from a prevention point of view but also because HIV vaccines are key to cure and remission of the virus.

Simultaneously, the vaccine would have a tremendous impact on improving public health, not only on HIV-related issues but also on other infectious diseases. For example, the long-term research conducted for an HIV vaccine played a crucial role towards the rapid development of a COVID-19 vaccine. 

Moreover, it has proven to be critical in paving the way for the development of vaccines for other diseases not only strengthening the networks of European research institutions but improving the necessary infrastructure. Thus, investing in an HIV vaccine undoubtedly means investing in pandemic preparedness, and in global health security.

Lastly, the development and distribution of an effective HIV vaccine have the potential to improve global health equity. It would ensure that everyone, regardless of their socioeconomic status or geographic location, has access to life-saving technologies, leaving no one behind. Additionally, an HIV vaccine would further protect vulnerable populations and reduce health disparities, contributing to the fight against HIV-related stigma and discrimination. By improving prevention and providing opportunities for greater control of HIV, an HIV vaccine would have a worldwide impact beyond Europe.

Vulnerable populations

Through its Global Health Strategy, the European Union is committed to deepening its leadership in global health matters, assuring that everyone everywhere has access to the highest attainable standards of health, based on solidarity and human rights. This will be achieved by, amongst other priorities, tackling the root causes of ill health, focusing on vulnerable populations, and working towards a mechanism that fosters the development of, and equitable access to, vaccines.

As the COVID-19 pandemic made clear, the EU has an unprecedented opportunity to become a global health leader. Investing in the development of an HIV vaccine that can save the lives of people all over the world must be a fundamental part of this strategy, with positive benefits for individual health and human rights, as well as for economies and health security.

It is time to invest in R&D for an HIV vaccine. It is time to ensure that the HIV pandemic no longer poses a threat to public health and individual well-being, and by doing so, protect human rights and advance equity. It is time to end AIDS.

Frances Fitzgerald is a Member of the European Parliament, Ireland

Sirpa Pietikäinen is a Member of the European Parliament, Finland

Sara Cerdas is a Member of the European Parliament, Portugal

Cyrus Engerer is a Member of the European Parliament, Malta

Antoni Comín i Oliveres is a Member of the European Parliament, Spain

Catharina Rinzema is a Member of the European Parliament, The Netherlands

Marc Angel is a member of the European Parliament, Luxembourg

Image Credits: Ehimetalor Akhere Unuabona/ Unsplash.

Global temperature
Industrial fossil fuel emissions are one of the primary causes of global warming.

In the next four years, there is a 66% chance that global temperatures will rise by at least 1.5°C – the limit set by the Paris Agreement. There is also a 98% likelihood that the world will live through the warmest year on record. 

This is according to the latest Global Annual to Decadal Climate Update issued by the World Meteorological Organization (WMO) on Wednesday.

The WMO report points out that global temperatures are set to reach unprecedented levels in the next five years due to greenhouse gases and an El Niño event expected to develop in the coming months. 

“The annual mean global near-surface temperature for each year between 2023 and 2027 is predicted to be between 1.1°C and 1.8°C higher than the average over the years 1850-1900,” the report states.

The average global temperature in 2022 was around 1.15°C higher than the average recorded during the 1850-1900 period. 

The benchmark of comparison is the average temperature during pre-industrial 1850-1900, before fossil fuel emissions started. 

Will the Paris Agreement limits be breached?

“This report does not mean that we will permanently exceed the 1.5°C level specified in the Paris Agreement which refers to long-term warming over many years. However, WMO is sounding the alarm that we will breach the 1.5°C level on a temporary basis with increasing frequency,” Dr Petteri Taalas, the secretary-general of the WMO said in a press release. 

“This will have far-reaching repercussions for health, food security, water management and the environment. We need to be prepared”.

In 2015, world leaders at the UN Climate Change Conference (COP21) in Paris reached an agreement to reduce greenhouse gas emissions to contain the global temperature increase to 2°C in this century. The leaders further agreed to pursue efforts to limit the increase to 1.5°C and to review their commitments every five years.  

When the Paris Agreement was signed, the chance of global temperatures temporarily exceeding 1.5°C was close to zero. However, the likelihood of the temperature exceeding 1.5°C has only increased since. 

The third global stocktake is scheduled to take place in 2023, where all the parties to the Paris Agreement will take inventory of the progress towards meeting the goals set out in the agreement. 

What is driving up the temperature?

The sharp increase in the emission of heat-trapping greenhouse gases is one of the two major factors pushing up the global average temperature. 

Greenhouse gases like carbon dioxide and methane trap the sun’s heat within the atmosphere, thus increasing the temperature. While these gases are present in the atmosphere naturally, human activity and industrial emissions increase the quantity of these gases. 

The other major factor outlined in the report is El Niño. An El Niño weather pattern anticipated later this year is expected to drive up the global temperature in 2024, breaking the record set due to a strong El Niño in 2016.

El Niño is a phenomenon in which the ocean surface becomes warm in certain parts of the Pacific Ocean. El Niño phases are expected to last for around four years. The last time El Niño was active was in 2016 when the global average temperature was 1.26°C higher than the pre-industrial average.  

Regions like Indonesia, the Amazon and central America are expected to receive less rainfall compared with the average rainfall received in these regions during 1991-2020. On the other hand, regions like the Sahel (in Africa), northern Europe, Alaska and northern Siberia are expected to receive higher than average rainfall in the May-to- September period between 2023 and 2027.  

The report was released ahead of the World Meteorological Congress, scheduled to take place in Geneva, Switzerland, from 22 May to 2 June. 

Image Credits: Photo by Marcin Jozwiak on Unsplash.

Plastic Pollution
The UNEP report sets the stage for the second round of international negotiations on a global treaty to fight plastic pollution, set to begin in Paris on 29 May.

Cutting global plastic pollution by 80% by 2040 is within reach if countries and companies commit to deep systemic changes in the way the world consumes and produces plastics, according to a United Nations Environment Programme (UNEP) report released on Tuesday.

The roadmap set out by the report is remarkably low-tech: reuse, recycle, and replace plastic products where greener solutions exist. With nearly 500 million tons of plastic being produced every year, and only 9% of it being recycled, the first step to addressing the plastic crisis is to make less of it, UNEP said.

“The way we produce, use and dispose of plastics is polluting ecosystems, creating risks for human health and destabilizing the climate,” said UNEP Executive Director Inger Andersen. “This report lays out a roadmap to dramatically reduce these risks through adopting a circular approach that keeps plastics out of ecosystems, out of our bodies and in the economy.”

By eliminating unnecessary plastics like excessive supermarket packaging, boosting the use of reusable bottles and containers, and finding greener alternatives to single-use plastics, government and industry could drive plastic pollution down to 40 million tons per year in 2040. In a business-as-usual scenario, plastic pollution would jump to 227 million tons in that same period.

Achieving this 80% reduction in plastic pollution could cut global carbon dioxide emissions by 500 million tons annually, equivalent to the emissions of Canada, and result in a net increase of 700,000 jobs by 2040, mostly in low-income countries, the report estimated.

The shift to a circular plastic economy would also prevent social and environmental damages valued at $3.2 trillion, according to UNEP. These savings account for impacts on health, climate, air pollution, water supplies and damage to ocean ecosystems, among other externalities.

“When you take all those [health costs] along with the cleanup costs of plastic pollution, you get in the range of $300 billion to $600 billion a year,” Steven Stone, deputy director of UNEP’s industry and economy division and lead author of the report told WIRED. “This report is a message of hope – we are not doomed to incurring all of these costs.”

Solutions in report do not solve everything

“Even with the market transformation approach described [in the report], a significant volume of plastics cannot be made circular in the coming 10 to 20 years,” the report said.
The authors of the UNEP report acknowledge the circular economy approach is not a panacea. Even under the best-case scenario, largely viewed as theoretical by environmental groups, 136 million metric tons of plastic will end up in landfills, incinerators and the environment by 2040.

Meanwhile, recycling – which the report relies on for 20% of the projected reduction in plastic pollution by 2040 – has until now proven ineffective when it comes to plastics, a problem projected to continue as the chemical make-up of plastics becomes increasingly complex, making them harder to recycle.

Recycling capacity has also failed to scale fast enough to keep pace with booming plastic production. The 2023 Plastic Waste Makers Index, an annual report of reference that tracks the activities of companies responsible for plastic production and pollution, called recycling “at most, a marginal activity for the plastics sector.”

“Despite rising consumer awareness, corporate attention, and regulation, there is more single-use plastic waste than ever before,” the index found. “Single-use plastic is not only a pollution crisis but also a climate one.”

The UNEP report comes just weeks ahead of the second of five rounds of international negotiations on a treaty to confront plastic pollution, set to take place in Paris later this month. The first round of negotiations, which took place in Uruguay in March of last year, was attended by over 2,000 experts and delegates from more than 150 countries determined to make their mark on the landmark treaty.

Jyoti Mathur-Filipp, the executive secretary of the Intergovernmental Negotiating Committee for plastics convening the negotiations, will present a zero-draft of a legally binding agreement at the meetings in Paris, which start May 29.

“This miracle material, [plastic], has in fact become a disastrous material insofar as the way we use and dispose of it,” Andersen said. “We need to take a full lifecycle approach to plastics. If we follow this [UNEP] roadmap, including in negotiations of the plastic pollution deal, we can deliver major economic, social and environmental wins.”

Familiar battle lines at a critical juncture for plastic pollution fight

Plastic
Plastic threads rest on a coral reef off the coast of Wakatobi National Park, Indonesia.

Plastics are everywhere. They are in our clothes, food, drinking water, blood and air. Microplastics have scaled Mount Everest, a feat achieved by just 4,000 human climbers in history, independently formed island-state sized garbage patches, and are set to outnumber fish in the world’s oceans by 2050.

Ingested microplastics are starting to alter the behaviour of cells in the internal organs of humans and animals. Their invasion of the world’s oceans is suffocating phytoplankton, interfering with the ability of oceans to work as a carbon sink.

Yet last year’s meeting in the coastal Uruguayan city of Punta del Este was the first time the world agreed on the notion of plastic pollution as a global crisis on the level of climate change and biodiversity loss, and that something should be done about it.

While recent successes on the climate and biodiversity fronts provide reason for optimism, the first round of negotiations saw the emergence of clear and familiar battle lines that foreshadow a rocky road between Paris and the final agreement, set to be ratified in 2024.

The self-styled High Ambition Coalition to End Plastic Pollution, a group of 50 countries led by Norway and Rwanda who want to end plastic pollution by 2040, sit on one side of the negotiating table. They want the outcome of the plastic treaty negotiations to be a legally binding instrument to achieve that goal.

Plastics
Top 20 global producers of single-use plastics remain effectively unchanged since the first Plastic Waste Makers Index was published in 2019.

The world’s largest energy, chemical and plastics producers – flanked by fossil-fuel-producing countries like the United States, China and Saudi Arabia – sit across from them. They are pushing for the global agreement to focus on voluntary commitments determined at the national level, rather than binding global standards.

This coalition also placed a heavy emphasis on recycling as a core building block of the international accord, a premise which has long been promoted by the plastics industry. Similar to the concept of the “environmental footprint” pushed by British Petroleum to deflect the blame for climate change from oil giants to everyday people, recycling allows plastic producers to blame the careless consumer for failing to recycle properly.

The presence of industry groups like the American Chemistry Council – which includes ExxonMobil, Shell and Dow among its near 200 members – has brought renewed criticism from environmental and human rights groups, who have grown exhausted with the UN allowing the companies responsible for environmental crises to attend high-level international negotiations intended to solve them.

ExxonMobil, the world’s largest plastic producer, touted “one of the largest advanced recycling facilities in North America” in an April earnings call where it announced a record $56 billion in annual profits. The facility can process over 80 million pounds of plastic waste per year, the company said. In 2021, Exxon produced 13.2 billion pounds of plastic polymers – 165 times what its new facility can process annually.

“What we know from historians is that since the 1950s, the industry has developed a very sophisticated system to defend their products, and that system includes lobbyists, consultants, but also scientists – and that’s what’s concerning me most,” Martin Wagner, a biologist specialized in the environmental impacts of plastics and synthetic materials at the Norwegian University and Science and Technology told Plastisphere.

“What the chemical industry has learned from the tobacco industry is that … manufacturing doubt and preventing scientific consensus on one of their products is [very powerful],” Wagner said. “Given the history of the sector to lobby for regulation that is not in any way restricting their business, I think the plastic industry’s role in negotiations should be as minor as possible.”

Image Credits: QPhia.

Landlocked equatorial Burundi is one of the poorest countries in the world – yet it scored the highest out of 58 countries for its plans to integrate health measures into its climate mitigation plan, getting an almost perfect score of 17 out of 18.

Low- and middle-income countries were far more likely to include health goals in their climate commitments than more wealthy, industrialised nations that are responsible for the majority of global greenhouse gas emissions.

This is according to an analysis published on Tuesday by the Global Climate and Health Alliance (GCHA), a coalition of over 150 health and development organisations working to tackle climate change.

The alliance analysed the climate plans of 58 countries – which are called nationally determined contributions (NDCs) in terms of the Paris Agreement on climate change. All countries that are party to this agreement have to develop NDCs to cut emissions and adapt to climate impacts, submit these plans to the United Nations Framework Convention on Climate Change (UNFCCC) and update them every five years.

The countries included in the alliance’s NDC Healthy Scorecard were those that had submitted their plans between 1 October 2021 and 23 September 2022. 

Greater ambition

“Overall, the Healthy NDC Scorecard demonstrates a trend of low- and middle-income countries showing greater ambition for protecting their citizens’ health from the worst impacts of climate change, while identifying additional wins through health co-benefits of climate action,” said Jess Beagley, Policy Lead at the Global Climate and Health Alliance. 

Each NDC was assigned a health score, with a total maximum of 18 points available across six categories – health impacts of climate change, actions in the health sector itself, recognition of health co-benefits of climate action in other sectors, economic and financial considerations, and monitoring and implementation. 

For example, countries get points for how well different parts of government are integrated to address climate change, how the health sector is being adapted to address climate threats, whether there is a budget, if the health impacts of climate change are quantified in terms of their cost, and whether there are particular targets that are set out, that relate to health, that governments can e held accountable to.

Where available, data from Climate Action Tracker has been included to evaluate the country’s level of ambition with regard to its emissions reduction target, its key commitment to mitigating climate change and limiting global warming.

“The NDC of Burundi is really exemplary,” said Beagley.  “It really does do almost the maximum in terms of integrating health into the NDC.”

Burundi’s plan includes the need to address a likely increase in the spread of vector-borne disease and flooding. A spinoff of its “vulnerability analysis” includes plans to power 455 health centres with solar energy.

Health considerations are part of its plans related to agriculture, energy, transport and water. It has a budget, indicators and timelines. 

Some wealthy nations score zero

Some wealthy nations, including Australia, Japan and New Zealand scored zero, reflecting the lack of any reference to health and climate linkages in their NDC. 

Meanwhile, the NDC emissions targets of some G20 nations, including Indonesia and Saudi Arabia, as well as of COP28 host the United Arab Emirates and COP27 host Egypt, received the worst rating available on the scale used by Climate Action Tracker. 

“Their climate mitigation targets contained in their NDCs align with over 4°C of warming, far beyond the 1.5C target agreed under the Paris Agreement, and putting the world on track for catastrophic and irreversible climate change impacts,” according to the alliance.

Jeni Miller, executive director of the Global Climate and Health Alliance.

“Although COP28 is being marketed as the ‘Health COP’, the Healthy NDC Scorecard scores make it clear that virtually none of the countries most culpable for climate warming appear to be clearly focussed on protecting the health of their citizens, or people around the world, when making climate commitments”, said Dr Jeni Miller, executive director of the Global Climate and Health Alliance. 

“This is despite promising to protect people’s ‘right to health’ when adopting the 2015 Paris Agreement, as well as endorsing the ‘right to a healthy environment’ at COP27”.

Image Credits: UNHCR.

Artificial sweeteners don’t help to control weight and may cause long-term health issues, says WHO.

Artificial sweeteners should not be used to control body weight or reduce the risk of non-communicable diseases (NCDs), according to a World Health Organization (WHO) guideline issued on Monday. 

“Non-sugar sweeteners (NSS) are not essential dietary factors and have no nutritional value. People should reduce the sweetness of their diet altogether, starting early in life, to improve their health,” according to Francesco Branca, WHO Director for Nutrition and Food Safety. 

“Replacing free sugars with NSS does not help with weight control in the long term. People need to consider other ways to reduce free sugars intake, such as consuming food with naturally occurring sugars, like fruit, or unsweetened food and beverages,” he added. 

The recommendation applies to all people except those with pre-existing diabetes and includes all synthetic and naturally occurring or modified NSS that are not classified as sugars found in manufactured foods and beverages, or sold on their own to be added to foods and beverages by consumers. 

Common NSS include acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives.

Toothpaste, skin creams excluded

“The recommendation does not apply to personal care and hygiene products containing NSS, such as toothpaste, skin cream, and medications, or to low-calorie sugars and sugar alcohols (polyols), which are sugars or sugar derivatives containing calories and are therefore not considered NSS,” according to the WHO.

The recommendation is based on the findings of a systematic review of the available evidence which suggests that the use of NSS does not confer any long-term benefit in reducing body fat in adults or children – and long-term use could potentially increase the risk of type 2 diabetes, cardiovascular diseases, and mortality in adults.

The systematic review included 64 prospective cohort studies conducted in adults, 15 cohort studies in children, one cohort study in children and adults and 17 cohort studies in pregnant women.

Although a short-term benefit of NSS use on measures of body fatness was observed in controlled experimental settings, the WHO concluded that there was little evidence that long-term use of NSS is beneficial for body weight – and the possible long-term adverse effects in the form of increased risk of death and disease offset any potential short-term health benefit resulting from the relatively small reduction in body weight and BMI observed in randomized controlled trials. 

In addition, limited evidence for the beneficial effects of NSS use on dental caries was observed in studies of children using stevia. But this was generally only observed in studies where NSS use was compared to sugars.

“This suggests that NSS do not have any inherent properties that impact the risk of dental caries; rather, the effect is a result of displacing free sugars,” the WHO noted.

But because the link between NSS and disease outcomes might be confounded by baseline characteristics of study participants and complicated patterns of NSS use, the recommendation is conditional, following WHO processes for developing guidelines. 

“This signals that policy decisions based on this recommendation may require substantive discussion in specific country contexts, linked for example to the extent of consumption in different age groups,” the WHO concluded.

Industry disappointment

However, the International Sweeteners Association contested the guideline, arguing that their products “continue to be a helpful tool to manage obesity, diabetes and dental diseases”.

The association added that it is  “disappointed that the WHO’s conclusions are largely based on low certainty evidence from observational studies, which are at high risk of reverse causality”. 

Image Credits: Towfiqu Barbhuiya/ Unsplash.