A new WHO Climate Change and Health Action plan was approved by a key World Health Assembly (WHA) Committee Tuesday evening – after hours of high-stakes, high-drama parliamentary maneuvers by a cluster of oil-rich World Health Organization (WHO) member states to shelve the plan failed.  

WHO member states accepted the original plan by a vote of 109-0, with 19 abstentions. Hours earlier, the WHA rejected a Saudi-led initiative to delay approval of the plan for another year by a vote of 86-23 with 11 abstentions. The Saudi initiative was backed by Russia as well as other countries of WHO’s Eastern Mediterranean Region (EMRO), which includes oil rich Gulf states, and Iraq, Iran and Libya.

A final vote on the actual climate and health action plan was delayed for hours by a range of procedural and technical maneuvers, including two more sets of proposed amendments proposed by EMRO, which failed, as well as a series of debates and procedural questions about how to vote and the order in which the voting should take place.  

The debate was unusual as it focused on an action plan linked to a new WHA resolution on Climate Change and Health that had already been approved last year by an overwhelming majority of WHA members. As the very last item on this year’s packed WHA agenda, it also delayed the closing of the entire Assembly by several hours.

Near 6 pm Egypt’s delegate proposed yet another last-minute amendment “in the spirit of consensus” which provoked another procedural vote, when Peru asked to close the debate.

As the amendments and procedural motions dragged on for hours into the evening, delaying the final vote for longer and longer, it was clear that opponents of the measure were exhausting member states, but proponents remained in the room to see the measure over the goal.

“We’re really testing the rules of procedure today,” quipped WHO legal counsel, Derek Walton at one point.

Even after all of the amendments were exhausted and it appeared that the plan had finally been adopted by consensus, Egypt’s delegate objected once more, saying that the EMRO region could not support it.

That led to the final, definitive ballot by member states on the action plan –  which was overwhelmingly approved.

Claims of insufficient consultations and misalignment?

The plan’s opponents maintained that there were insufficient consultations, although WHO and member states held multiple rounds of talks with member states at regional and global level over the past year.

In its statements Monday and Tuesday, Saudi Arabia also seemed to suggest that WHO should not be supporting developing countries’ efforts to access clean energy or mitigate emissions because historically they pollute less.

“As an oil producing sector, we are aware of our role in [energy] transformation, but can’t ask developing countries to pay the price for transformation when they are not responsible for the problems,” said the Saudi delegate, during the initial debate.

Saudi Arabia wanted a postponement of the action plan until next year, until the plan “can be aligned with different national contexts… and to take due account of national diversity.”

But in the final ballot of the day, Saudi and other EMRO states abstained from voting rather than be counted amongst the plan’s opponents.

Saudi Aramco’s economic stake in more fossil fuel expansion

Saudi has a clear national political and economic stake in defining WHO’s climate and health agenda as narrowly as possible.  

Its own state-owned oil company, Saudi Aramco, has the biggest fossil fuel expansion plans of any major oil and gas multinational, overshooting a 2022 International Energy Agency’s scenario for net zero emissions by more than any other multinational. 

WHO’s advocacy around shifting health facilities to cleaner and renewable energy sources, and around the co-benefits to health that low-carbon transport, cities, and economies may rub member states that aspire to keep the world on a fossil fuel economy for decades to come in the wrong way.   

Battleground Africa 

Sandwiched in the middle of the debate are low-income countries, particularly in Africa, whose governments stand to benefit from large oil and gas projects – but are also bearing the biggest brunt of climate’s impacts. 

As Mozambique’s delegate stressed Monday, on behalf of the 47 African member states: “The African region is disproportionally impacted by climate change, and although our continent contributes minimally to the global emission it bears the greatest burden.”

The African group supported the “full adoption of the global action plan on climate change and health,” he concluded. 

Africa, with its low present-day levels of fossil fuel consumption and emissions but rich mineral reserves locked in rich tropical forests, peatlands, and offshore, represents one of the last frontiers for multinational oil and gas companies to both expand extraction and consumption dramatically, keeping the world on a firmly fossil fuel trajectory for another 50 years. 

In contrast, Asia, led by China, is investing more heavily in renewables. Even India’s massive Adani Group is now investing heavily in solar, wind and hydropower,  even if  coal and oil remain economic mainstays for CEO Gautam Adani, a close associate of Prime Minister Nahrendra Modi.  

Developed nations calling for healthier, low carbon development

Conversely, many European and other developed nations want WHO’s work to also focus on healthier, more low-carbon strategies that reduce the trajectory of future climate emissions  – alongside adaptation to the inevitable.

Those nations have called on WHO to support national plans for healthier non-motorized and electric transport; urban and building design; as well as nutrition options which also reduce carbon emissions. They have also called on health facilities efforts to “decarbonize” their own high-emissions operations. 

“As a health community, we therefore have a two-fold responsibility firstly, promoting climate measures by positioning the health argument as a strong driver of increased climate ambition,” said Poland, speaking on behalf of 34 member states, including the European Union. 

“This means stimulating broader awareness and education in climate and health and incentivizing other sectors, such as the transport sector on active mobility and the food sector on sustainable and healthy diets.”   

 Clean, reliable energy in low-income countries 

Beyond the rhetoric and oft-artificial divide of adaptation and mitigation, African nations appear eager to get WHO’s help to introduce cleaner, greener energy for thousands of  health facilities that lack reliable power, or those that lack any reliable power at all. 

As Mozambique said: “We call for urgent action to build climate resilient health systems across the continent.”  

A 2023 WHO study estimated that 12-15% of health facilities in South Asia and SubSaharan Africa respectively lack access to any electricity at all. 

About half of the health centres in sub-Saharan Africa also lack reliable electricity, according to WHO data. This shortage disrupts essential services such as emergency care, maternal health services, and vaccine refrigeration.

And one billion people worldwide are served by health facilities with no electricity or unreliable electricity services.  See related story: 

One Billion People Lack Access to Health Facilities with Reliable Electricity

Through its ATACH initiative, WHO has been working with countries to build climate resilient and low-carbon sustainable health systems. 

Its efforts have been supported by the International Renewable Energy Agency (IRENA) as well as foundations and philanthropies that are helping health actors access finance as well as plan energy systems that not only bring them electricity, but also ensure their financial sustainability.  

IRENA, as well as the International Energy Agency have long argued that the distribution of health facilities in rural Africa is such that renewable energy or hybrid systems, delivered through mini-grids, are the only affordable and practical solution – than grid power, delivered from centralized, fossil fuel plants. 

Disruptive agenda?

But such initiatives, however modest, are also potentially disruptive. If the politically weak health sector demonstrates that it can electrify with renewables, then why not other more powerful productive sectors, like agriculture, and households? 

The African Development Bank’s Power Africa Initiative, launched by US President Barack Obama in 2013, has been supporting efforts to develop renewable energy grids in rural and off-grid locations – as the quickest and cheapest way to electrify African communities and households. 

Some 600 million Africans lack any electricity access whatsoever, and thus rely upon polluting wood and other biomass for cooking as well as kerosene for lighting — leading to one of the world’s largest disease burdens from household air pollution exposures. 

Meanwhile, an ambitious new African Energy fund aims to connect about 300 million Africans to electricity, through stepped up development of renewable sources, through a new $40 billion African Energy Fund, part of a new ADB initiative launched in February.  

But in the wake of the collapse of USAID, a major Power Africa partner, and the withdrawal of the United States from African clean energy initiatives, their fate remains unclear. US policy, heavily oriented towards more fossil fuel extraction at home and abroad, is unlikely to support renewables in Africa for the duration of the Trump Administration’s term. 

While the US was not present at this World Health Assembly, if they had been, they would have been cheering on the Saudi and Russian efforts. 

Image Credits: Rainforest Foundation and Earth Insights, 2022, Adani Group , Netcare-Alberton Hospital, WHO, T20 Policy Brief, July 2023.