Measles case US 2026
Measles cases have surged in several US states – the highest number of cases since 1991.

Plummeting vaccination rates have fueled a historic and prolonged wave of measles in the US – with the Pan American Health Organization expected to revoke the country’s elimination status it enjoyed since 2000. Experts told Health Policy Watch that the shifting vaccination landscape and persistent cases globally have fueled the worst outbreak since 1991.

WASHINGTON – The Pan American Health Organization (PAHO) is expected to revoke the US’s measles elimination status this week, ending a 26-year streak of little-to-no local transmission in a country that once declared victory over measles.

More than 5,200 cases of measles have been reported across the country by the Centers for Disease Control and Prevention (CDC) this year. Cases are likely to continue climbing. In contrast, in 2000, the year the measles was declared eliminated in the US, the CDC reported 85 cases.

Outbreaks in Pennsylvania, South Carolina, Texas, Utah, among other states have fueled governors to declare states of emergency and plead residents to vaccinate their children. 

The CDC has reported six deaths from measles this year, though state and local officials in New York and Wisconsin have reported two additional deaths, bringing the total to eight deaths from the vaccine-prevantable yet highly contagious virus.

Measles US
Weekly measles cases in the US from 2019- 2026. The past year’s resurgence in cases means the US loses its measles elimination status.

“It is unthinkable that people in the United States should be dying from measles in 2026,” said Dr Wendy S Armstrong, president of the Infectious Disease Society of America, in a statement 12 November. “For nearly 30 years, the measles virus posed little threat in the United States because of strong public health leadership and trust in science.”

At this pace, there is little question the US will lose its measles elimination status, infectious disease and public health experts told Health Policy Watch. “The only reason that the US could retain its status is through raw political pressure on PAHO,” said Dr Lawrence Gostin, distinguished university professor in global health law at Georgetown University.   

PAHO experts met on the issue last week and the agency, the regional affiliate of the World Health Organization in the Americas, will announce its final decision on Tuesday. 

Continuous measles outbreaks in several states

Measles Utah
A snapshot of the state of Utah’s MMR vaccination rates. Several counties have less that 80% measles vaccination coverage. The state has seen over 500 cases in the past year.

Measles elimination occurs when there is more than a year without any endemic (locally transmitted) cases of measles. It is lost when an outbreak is sustained for more than a year.

The US outbreaks, which began in early 2025 have hit states across the country, racing unabated in unvaccinated communities. Notably, this year marks the first time in several decades that the cases are primarily locally-transmitted. Prior to 2025, measles outbreaks typically began with imported cases from Americans traveling abroad, explained virologist Dr Angela Rasmussen and pediatrician Dr Anita K Patel in a newsletter.

Measles map US 2026
Measles cases in the US. Pennsylvania, South Carolina, and Utah have seen a resurgence of the vaccine-prevantable disease.

“There were usually anywhere between 50-100 imported cases per year, with very little onward transmission,” they said. Now, though, the outbreak in Utah has been continuously spreading for more than a year- “the US will lose elimination status on the basis of that outbreak alone.”

Local transmission is also a key consideration for the PAHO independent technical body of infectious disease experts evaluating the US elimination status. The experts look at genetic sequencing data to determine whether an outbreak is driven by the same viral genotype, and whether that viral “family” caused disease across multiple communities, as compared to infections emerging from imported cases.  

International body to deliberate elimination status after postponement

Pan American Health Organization PAHO
PAHO headquarters in Washington, DC in 2026. The Organization fended off speculation that the meeting postponement was due to US political pressure.

The PAHO expert session, held 10-13 November, was postponed from April. The Organization pushed back against accusations that postponing the elimination review to a date after the US midterm elections was due to political pressure. The panel reviews all countries in the region of the Americas. Mexico, for instance, also has faced severe measles outbreaks this year and may well lose its elimination status as well, experts said.

While the loss of the US’s measles elimination status has no legal or practical consequences, “[i]t does send an urgent warning that measles transmission is unchecked and that our vaccination system has broken down,” said Gostin in a statement to Health Policy Watch. Gostin, an expert in global health law and founding chair of Georgetown’s Global Health Law center, noted that the loss of status is a blow to the US’s “political and moral authority” in a time when its global health leadership is in flux. 

“Countries around the world are already deeply skeptical of the political will to prevent transmission of childhood diseases,” Gostin said. Bangladesh, Indonesia, Guatemala, India, Yemen, Pakistan,and Angola accounted for the majority of the global disease burden in 2025. Cases spread internationally through unvaccinated travelers. 

‘Entirely preventable’

Measles vaccination US 2026
Measles vaccination coverage has slipped significantly in the past decades, leaving “pockets of vulnerability” for infection. The map displays 2025-26 coverage.

The US achieved elimination status over 25 years ago, marking a victory over a disease that once infected nearly every child and claimed 500 deaths per year before widespread vaccination.  

The outbreak that began in January 2025 “has not stopped,” said Rasmussen and Patel. “It has turned into a series of never-ending outbreaks flaring up nationwide.”

The pair write that “unequivocally” the outbreaks could have been prevented. “This is a national crisis and the worst part about it is that it was completely preventable.” They and others advocate that bumping the US’s vaccination rates is the solution to the number of cases not seen since 1991.

Slipping vaccination coverage in the US has left “pockets of vulnerability,” said Dr Michael Osterholm, an epidemiologist and director of the Center for Infectious Disease Research and Policy (CIDRAP). In the US, 96% of all infections occurred in unvaccinated individuals.

Measles vaccination map US 2009-10
Vaccination coverage in 2009-10 in the US was higher than it is now. Experts believe a combination of low vaccination rates and a high global prevalence have fueled the current outbreak.

The combined measles, mumps, and rubella vaccine (MMR) is 97% effective after two doses. Children 12-15 months receive a first dose, followed by a second dose when 2-4 years of age.

In the 2025-26 school year, 18 US states had vaccination rates below 90%. In 2010, only six states fell below 90%, according to CDC data.

And when using the WHO’s threshold for herd immunity – 95% – only 10 states currently meet that criteria.  

Successful vaccination campaigns in upper income countries, followed by a drop in vaccinations have left these countries especially vulnerable to measles outbreaks. In some communities, an entire generation of young adults have no protection – either from infection or vaccination.

“Those are pockets of vulnerability where all it takes is one case to get introduced, and it’s like a spark in a forest fire, it takes off quickly and dangerously,” said Osterholm.

Worries over congenital measles

A doctor examines a child with measles. The growing number of adults with no measles protection has led to a rise in congenital measles.

“The expected loss of America’s status as having eradicated measles will be a tragedy because it reflects the preventable loss of human lives,” said Armstrong of the IDSA. “Perhaps most heartbreaking is the potential long-term toll on infants infected this year, some of whom may develop fatal neurologic disease years after the initial infection.”

Infants under one year of age are largely ineligible for the vaccine, making them particularly vulnerable.

Armstrong also alluded to the fact that for the first time in decades, congenital measles, which is passed from an infected pregnant woman to her newborn, now poses a serious public health threat. 

This is because as people who were never vaccinated, or even exposed to measles as children, have children themselves, they risk passing the disease to the most vulnerable.

Now, there is a growing number of pregnant women who were infected with measles, said Osterholm. Again, that is due to the lack of protection among adults for the first time. In prior generations, nearly all adults were either infected or vaccinated as children. 

This poses a challenge to healthcare providers, who may have never treated measles in pregnancy. 

The Pennsylavian Department of Health, which is coordinating the response to the largest current outbreak in the US, said “[b]ecause measles was declared eliminated in the United States decades ago, modern data related to measles during pregnancy and the related risks is limited,” The DOH also said despite the limitations, “clinical studies and systematic reviews provide clear statistical evidence of the dangers associated with contracting measles while pregnant.”   

Experts point to US political leadership as casting vaccine doubts

When asked how the US ended up with such a large number of cases, some experts argued that inconsistent messaging has led to confusion and unvaccinated communities. 

“Mis- and disinformation about measles vaccines continues to haunt us,” Osterholm told Health Policy Watch. He argued that the inconsistent messaging from the federal government sets the US apart; other nations with similar high burdens have deployed concerted vaccination efforts.

Others went further: “The failure rests directly with our political leadership in health,” argued Gostin. “The Secretary of HHS has actively fueled conspiracy theories such as the link between MMR vaccines and autism. He has also cast doubt on vaccine safety. This failure is a direct consequence of an administration that lacks fidelity to science and public health.” 

Gostin said that “[t]he end of measles elimination in the US has been under Secretary Kennedy’s watch, and he should be held politically accountable by the President and Congress,” echoing calls from some on the political left for the removal of US health officials from office.   

Other countries battle measles

In January, the UK, Spain, Armenia, Azerbaijan, and Uzbekistan lost their measles elimination status after the Europe and Central Asia regional committee met to review the status. 

PAHO,  or the WHO Region of the Americas, on the other hand, has historically been the WHO Region that is home to the most countries to reach elimination status.

Beyond the US, other oubreaks in Canada, and Mexico futher threaten that status.  

Mexico has recorded over 50 measles-related deaths this past year. And globally, 95,000 measles deaths occur each year, mostly among unvaccinated or under-vaccinated children under the age of five. 

Cases and deaths are mostly concentrated in low- and middle-income countries and in low-resource or conflict settings.

The disease is one of the most contagious viruses that can lead to severe complications and death, according to the WHO. Vaccination, though, averted nearly 59 million deaths in the past quarter-century.

The measles virus infects the respiratory tract and then spreads throughout the body. Symptoms include a high fever, cough, runny nose and a rash all over the body, per the WHO.

See related story:

US Measles Elimination Status Review Postponed for ‘Technical Reasons’, Says WHO

 

Image Credits: Johns Hopkins, Johns Hopkins University, Utah Health and Human Services, CDC, S. Samantaroy, WHO.

Diabetes screening
During a routine screening visit at a primary health care centre, Ms. Wangmo undergoes a blood glucose test as part of the Services with Care and Compassion initiative.

The SEAHEARTS initiative in WHO’s South-East Asia Region offers an outstanding example of how we can build health systems that address diabetes and other related conditions – worth special attention on World Diabetes Day, as we grapple with the growing number of people worldwide living with the condition.

When 64-year-old Wangmo from Pemagatshel District in Bhutan accompanied her mother to a primary health care centre for a routine blood sugar check, she did not expect the visit to change her own life.

Offered diabetes screening under Bhutan’s new ‘Services with Care and Compassion’ initiative, she discovered that her blood glucose levels were elevated, despite feeling perfectly healthy. Early diagnosis enabled her to receive counselling, treatment and regular follow-up before serious complications could develop.

Her experience reflects a shift that health systems urgently need to make: from waiting for people to become ill to identifying risks early and bringing preventive care closer to communities.

On World Diabetes Day, global conversation often turns to the growing number of people living with diabetes and the need to improve access to early diagnosis and treatment. But a larger public health challenge deserves equal attention: how do we build health systems that prevent diabetes and cardiovascular diseases (CVDs), detect them early and ensure people receive sustained, quality care? 

Touching the lives of hundreds of millions

Fruits and vegetables market
Residents of Begun Kodar, West Bengal, India, shop for fresh fruits and vegetables at a local market.

Across the WHO South-East Asia Region (SEARO), home to more than 1.8 billion people, CVDs claim an estimated 11,800 lives every day. Nearly half of these deaths occur before the age of 70. Hypertension and diabetes, two leading causes of premature deaths, often go undetected or remain inadequately controlled, increasing the risk of heart attacks, strokes, kidney failure and premature death.

Addressing this challenge requires more than expanding treatment services. It demands an integrated approach combining prevention, early detection and effective long-term care. This approach underpins SEAHEARTS, a regional initiative launched by SEARO Member States in 2023 to accelerate the prevention and control of cardiovascular diseases and other noncommunicable diseases (NCDs).

Three years on, SEAHEARTS has chalked up impressive successes in extending prevention policies in health systems and across sectors – touching the lives of more than 1.75 billion people across the region in one way or another. It offers an important lesson: tackling the NCD epidemic requires governments to strengthen primary health care while acting decisively on the wider determinants of health.

A stronger focus on integrated prevention 

One of SEAHEARTS’ most significant contributions has been to bring together interventions that are too often pursued separately.

The initiative combines recommendations from four WHO technical packages targeting both health systems as well as health-in-all policies approaches. They include: HEARTS for cardiovascular disease management in primary health care; MPOWER for tobacco control; SHAKE for salt reduction; and REPLACE for eliminating industrially produced trans-fatty acids.

The rationale is straightforward. Better treatment of the risk factors that contribute to both hypertension and diabetes saves lives, but health systems cannot treat their way out of the NCD epidemic. 

Reducing exposure to tobacco, trans-fats and unhealthy diets is equally essential. This places responsibility not only on health services, but also on governments to shape healthier food environments, regulate tobacco products and introduce effective public health policies.

The results demonstrate what this integrated approach can achieve. More than 1.75 billion people are now protected from the harmful effects of industrially produced trans-fatty acids through strengthened policies and regulations in six SEARO member states. 

NCD policies graph
Figure 1: Coverage of SEAHEARTS milestones to prevent diabetes and cardiovascular diseases. Source: Data reported by ministries of health in the WHO South-East Asia Region, December 2025.

Some 285 million people in five member states are covered by at least one evidence-based salt reduction measure, while 103 million across two countries are protected by three or more WHO-recommended tobacco control interventions (Figure 1).

These gains show the value of combining population-wide prevention with accessible clinical care.

Early diagnosis in primary health care systems  

Blood pressure testing
A community health worker measures a woman’s blood pressure in Bang Phut Subdistrict, Thailand.

For people living with hypertension and diabetes, the difference between a manageable condition and a life-threatening complication often depends on early diagnosis, affordable medicines and consistent follow-up.

SEAHEARTS has helped make primary health care the foundation of this response. Between June 2024 and June 2026, the number of people with hypertension receiving protocol-based management across reporting countries increased from 39.3 million to 72.4 million. The number of people receiving protocol-based diabetes care rose from 22.9 million to 43.5 million (Figure 2).

SEAHEARTS diabetes hypertension
Figure 2: In just two years, the number of adults accessing hypertension treatment across WHO’s South-East Asia Region increased by nearly 85%. Source: Data reported by ministries of health in the WHO South-East Asia Region, June 2026.

Importantly, the expansion has been accompanied by improvements in disease control. The number of people with hypertension whose blood pressure was controlled increased more than sevenfold, from 2.2 million to 16.5 million. The number of people with diabetes achieving glycaemic control rose from 1.3 million to 8.4 million (Figure 3).

Diabetes care SEARO
Figure 3: The number of people accessing diabetes treatment in WHO’s South-East Asia Region nearly doubled between June 2024 and June 2026. Source: Data reported by ministries of health in the WHO South-East Asia Region, June 2026.

More than 185,000 public health-care facilities across 10 countries are strengthening hypertension and diabetes services. More than 107,000 health workers have been trained in early detection, accurate measurement of blood pressure and blood glucose, team-based care and long-term follow-up. Countries are also introducing longer medicine refills and digital systems to track patients over time.

These changes strengthen not just the management of two conditions, but the wider capacity of primary health care to prevent and manage NCDs.

Turning regional commitment into national action

No smoking
A no-smoking sign outside a shopping centre in Bangkok, Thailand, promotes a smoke-free environment.

Progress under SEAHEARTS reflects political commitment, national ownership and accountability. Following the adoption of the regional resolution in October 2023, Member States developed national roadmaps, established treatment coverage targets and designated focal points to monitor implementation and address bottlenecks.

Bhutan, India, Thailand and Timor-Leste achieved their national hypertension and diabetes treatment coverage commitments for 2025 and received the WHO Public Health Achievement Awards in 2026.

Thailand received WHO certification in November 2023 for eliminating industrially produced trans-fatty acids, supported by strong monitoring and enforcement systems. In Sri Lanka, regulations adopted in 2022 came into legal force in July 2026, alongside the establishment of dedicated laboratory capacity to support compliance.

On tobacco control, several countries have strengthened graphic health warnings on tobacco packaging. Maldives has gone further, approving in November 2025 a generational ban on the purchase, sale or use of tobacco products for anyone born after 01 January 2007 – even after they become adults.

These experiences reinforce a central policy lesson: ambitious targets must be backed by legislation, implementation capacity, monitoring and sustained political commitment.

From expanded coverage to sustained control

Blood glucose diabetes
A health worker checks a patient’s blood glucose level during a routine health check-up.

Despite the progress, significant challenges remain. Predictable financing is needed for essential medicines, diagnostics, trained personnel and digital infrastructure. Medicine stock-outs, missed follow-up visits and workforce turnover can undermine continuity of care. Services must reach underserved populations, while stronger engagement with private providers is needed to improve the quality and completeness of treatment data.

Equally important is ensuring that improvements in coverage translate into sustained clinical outcomes. This requires regular clinical audits, quality-improvement mechanisms and reliable data on whether people achieve and maintain blood pressure and blood glucose control.

Recognizing both the achievements and the unfinished agenda, Member States decided in October 2025 to extend and expand the SEAHEARTS initiative through 2030, with more ambitious milestones. 

The next phase places greater emphasis on treatment coverage and disease control, enforcement of trans-fat regulations, and stronger implementation of evidence-based tobacco-control and salt-reduction measures. 

In this second phase, SEAHEARTS success will be judged not only by the number of people covered by preventive policies, or by the number of health facilities implementing protocols and people enrolled in treatment programmes, but by whether fewer people develop preventable diseases, more people achieve sustained control of hypertension and diabetes, and everyone can access affordable, quality care.

A regional commitment with global relevance

We estimate that if countries sustain and expand these interventions, SEAHEARTS has the potential to avert more than 6.4 million deaths and 93 million disability-adjusted life years in the SEARO region between 2026 and 2050.

The experience offers lessons well beyond South-East Asia. It demonstrates how shared regional goals can accelerate national action, bring clinical and population-level interventions together, and strengthen accountability for results. Political leadership, evidence-based policies and strong primary health care can reinforce one another to deliver progress at scale.

A healthier heart should not depend on where a person lives or what they earn. It should be supported by health systems that prevent risks, detect disease early and provide effective care throughout life. That is the ambition of SEAHEARTS: to help millions live longer, healthier lives.

Dr Nilesh Buddha is the Officer-in-Charge, WHO South-East Asia Region

Dr Pradeep Joshi, Dr Nalika Gunawardena and Ms Sanjana Marpadga are technical focal points for NCDs in WHO South-East Asia Region

Dr Suman Rijal is Director of Department of Health Promotion, Disease Prevention and Control, WHO South-East Asia Region 

Image Credits: WHO, WHO / Rebecca Conway, WHO/ SEARO, WHO / Ploy Phutpheng, WHO / Conor Ashleigh, WHO / Enric Catala Contreras .

Championing primary prevention: Dr María Neira’s platform calls for using WHO’s normative authority to direct global capital toward environmental drivers before populations become patients.
Championing primary prevention: Dr María Neira’s platform calls for using WHO’s normative authority to direct global capital toward environmental drivers before populations become patients.

The World Health Organization (WHO) must rebuild public trust, protect its most important functions and resist across-the-board budget cuts as it confronts growing health threats and shrinking financial resources, according to Dr. Maria Neira, a candidate to become the agency’s next director-general.

“One thing that I will never do is to cut across and saying, OK, we need to reduce 20 percent. We will reduce everything by 20 percent. No, we need to be very strategic on what functions we maintain,” Neira said.

Speaking on the Inside Geneva podcast, produced in partnership with the Geneva Graduate Institute’s Global Health Centre and SWI swissinfo, Neira outlined her vision for WHO at a time when the United States has withdrawn, other countries are reducing funding and public confidence in health institutions is being challenged by misinformation.

A Spanish physician and former vice minister of health who has spent much of her career at WHO, Neira said reforms must focus on the agency’s core mandate rather than simply reducing costs. She identified antimicrobial resistance, rising rates of noncommunicable diseases, climate change and the continued lack of access to safe water and sanitation as urgent priorities.

“Something that for me is unacceptable and makes me really upset is the fact that today, in 2026, a lot of people still do not have access to safe water and sanitation,” she said.

Neira also acknowledged that WHO can no longer assume its scientific guidance will automatically be accepted, particularly following the COVID-19 pandemic.

“Communication is absolutely important,” she said. “Because now, as I say, it’s a question of gaining everyday credibility.”

She argued that restoring confidence will require transparent experts, stronger partnerships and clearer communication about WHO’s impact on everyday life.

“Credibility is linked to what you need to earn it. You need to demonstrate it every day,” Neira said.

Listen to the full podcast:

The interview series with WHO DG candidates is being co-produced by the SwissInfo media platform with the Geneva Graduate Institute’s Global Health Centre, as part of a media collaboration on the upcoming WHO election  also supported by Health Policy Watch.

See more about the candidates on Health Policy Watch’s special WHO election website.

Image Credits: WHO.

Activists protest the presence of fossil fuel industry groups at the COP31 UN climate summit in Antalya, Turkey, demanding polluters be ousted.
Activists protest the presence of fossil fuel industry lobbyists at the COP31 UN climate summit in Antalya, Türkiye, demanding polluters be ousted.

ANTALYA — More than 100 companies and industry groups with records of obstructing climate policy have sent delegations to the COP31 UN climate summit in Antalya that outnumber those of some of the world’s most climate-vulnerable nations, an analysis released Friday found.

The 103 groups, 60 of them from the fossil fuel industry, outnumber delegates from Saint Vincent and the Grenadines 100 to 1, Niger 25 to 1, the Philippines 8 to 1 and Nepal 6 to 1, according to the Kick Big Polluters Out (KBPO) coalition, which examined the summit’s provisional list of participants.

The report “exposes the invisible hand behind the false solutions campaign and the agenda fights we’re seeing at COP31,” said Rachitaa Gupta, lead coordinator of the Global Campaign to Demand Climate Justice.

“Allowing polluters to influence COP31 gives them legitimacy to continue with business as usual and breaches Global South communities’ trust in the COP31 process,” she added. “We cannot let the very systems responsible for the climate crisis take over climate negotiations.”

Each group was flagged because its lobbying is “notably misaligned with or obstructing climate policy,” based on scores from the think tank InfluenceMap. Thirty of the 100 banks that most finance fossil fuels also registered.

Together, they provided more than $2.2 trillion to the industry between 2021 and 2025, nearly 40% of all fossil fuel bank financing worldwide, according to the Banking on Climate Chaos database.

“You can’t put out a fire while handing the matches to the arsonists,” said Lien Vandamme of the Centre for International Environmental Law (CIEL), a KBPO partner. “And you certainly can’t expect the arsonists to write the evacuation plan.”

Who is in the room

Swedish climate activist Greta Thunberg, center, joins protesters at the COP31 summit in Antalya, Türkiye, demanding fossil fuel lobbyists be excluded.
Swedish climate activist Greta Thunberg, centre, joins protesters at the COP31 summit in Antalya, Türkiye.

The largest delegations came from the International Emissions Trading Association, with 29 people, BNP Paribas with 22, HSBC with 19 and Amazon with 12. ExxonMobil sent 13.

Most entered on “Party overflow” badges that governments hand to guests outside their official teams, or through nongovernmental organizations. Another 45 were guests of host Türkiye, and 31 sat on countries’ official negotiating delegations.

Asset manager BlackRock, which KBPO ranks among the most obstructive financiers, is on France’s delegation this year, the Guardian reported. Italy brought 50 fossil fuel industry representatives on its delegation, up from 12 at COP30, according to a separate count by the Fossil Free Politics campaign.

KBPO’s past tallies of fossil fuel lobbyists at UN climate negotiations counted a record 2,456 at COP28 in Dubai, nearly four times the number a year earlier. Another 1,773 attended COP29 in Baku, more than the combined delegations of the 10 most climate-vulnerable nations.

At COP30 in Belém, Brazil, the coalition counted 1,602, or one in every 25 participants, the highest share it has recorded.

Russia, Saudi Arabia and the Like-Minded Developing Countries (LMDCs), a negotiating bloc that includes China and India, the first and third-biggest emitters, and major oil producers such as Iran, Iraq and Venezuela, have repeatedly questioned whether the summit should produce an overarching political decision at all, Climate Home News reported, citing sources in the closed-door talks.

Swedish activist Greta Thunberg, attending her first UN climate summit since 2021, aimed her fire at the same industries on Thursday.

“The planet is not dying, it is being killed, and we know by whom,” Thunberg told reporters. “It’s more clear than ever in spaces like these that the situation could not be any less under control.”

“No one is coming to our rescue,” Thunberg added. “When our human rights are being threatened by states and other institutions, it’s our duty to stand up and be the adult in the room and fight for everyone’s human rights.”

Same faces at other UN environment talks

Oil and petrochemical lobbyists have flooded UN biodiversity and plastics talks alongside climate summits, fuelling demands for binding conflict-of-interest rules.
Oil and petrochemical industries have flooded UN biodiversity and plastics talks alongside climate summits, fuelling demands for binding conflict-of-interest rules.

At last month’s UN biodiversity summit in neighbouring Armenia, Shell, TotalEnergies, Bayer and Rio Tinto were among the attendees identified by the investigative outlet DeSmog, even though organisers had removed company names from the delegate list.

CIEL has tracked the same pattern at negotiations on a global plastics treaty. At the August 2025 round in Geneva, it counted at least 234 fossil fuel and chemical industry lobbyists, more than the combined delegations of the European Union and its 27 member states, Health Policy Watch reported.

Nineteen of them sat on the national delegations of Egypt, Kazakhstan, China, Iran, Chile and the Dominican Republic. The self-described “like-minded” group of oil and petrochemical producers led by Saudi Arabia, Russia and Iran blocked any limits on plastic production. The talks collapsed without a treaty.

KBPO and the UN process’s women’s, youth and trade union constituencies are calling for a binding conflict-of-interest policy to keep polluters from shaping the talks.

“We come from Nepal demanding justice,” said Prakash Dalal of Pro Public/Friends of the Earth Nepal. “We cannot tolerate the disproportionate space given to them compared to civil society and our country delegations.”

War windfall

Activists rally against militarism and fossil fuel interests at the COP31 climate summit in Antalya, Türkiye, holding banners opposing war.
Activists rally against militarism and fossil fuel interests at the COP31 climate summit in Antalya, Türkiye, holding banners opposing war.

The delegations arrive as oil majors book near-record profits from the war on Iran, which began with US and Israeli strikes in February and has choked shipping through the Strait of Hormuz.

ExxonMobil, Chevron, BP, Shell and TotalEnergies earned a combined $56.3 billion in adjusted net income in the third quarter, the third-highest total on record, according to data compiled by Bloomberg. International oil prices have climbed almost 60% since the war began.

UN Secretary-General António Guterres accused the industry on Wednesday of “making a killing while killing our planet,” in his final address to a UN climate summit, Health Policy Watch reported.

“Fossil fuels must go the way of the dinosaurs,” Guterres told world leaders. “But that won’t happen on its own. The dinosaurs did not have a lobby. But fossil fuels do.”

The nine largest oil companies made $95 billion in profit last quarter alone, he said, while the fund created at COP28 to pay for climate disaster losses has received around $600 million, roughly what those companies earn in 14 hours.

“It’s time for governments to tax these windfall profits,” Guterres said, “and use them to help vulnerable countries recover.”

Emissions still climbing

Smoking chimneys air pollution
Rising coal demand and deforestation are pushing total carbon emissions to a record high in 2026, threatening to exhaust the 1.5C warming budget.

Global fossil fuel emissions are projected to dip 0.4% this year to 38.2 billion metric tons of carbon dioxide, the Global Carbon Project reported on Tuesday in its annual report published at COP31.

Most of the decline comes from oil, down 1.9% largely because of the war’s energy shock. Coal emissions, meanwhile, are still rising, with the International Energy Agency (IEA) forecasting record coal demand this year as countries switch from expensive gas.

In its main scenario, the agency expects coal use to peak and oil demand to flatten around 2030, while gas demand keeps growing into the 2030s.

Including deforestation and other land use, total carbon dioxide emissions are set to reach a record 43.3 billion tons in 2026, up from 42.8 billion in 2025. At current rates, the world will use up its remaining budget for limiting warming to 1.5C in less than four years.

“A reduction driven partly by geopolitical shocks is not a sustainable climate solution,” said Pierre Friedlingstein of the University of Exeter, who led the study.

Fossil fuel industry sues governments over profits lost to climate action 

Inside the COP31 venue in Antalya, corporate and fossil fuel lobbyists outnumber delegations from vulnerable nations while obstructing global climate action.
Inside the COP31 venue in Antalya, corporate and fossil fuel lobbyists outnumber delegations from vulnerable nations while obstructing global climate action.

The industry is also using private tribunals to challenge climate policies, according to a separate analysis published Thursday by PowerShift, Global Justice Now and the European Trade Justice Coalition.

Fossil fuel and related companies have claimed at least $443 billion from governments through investor-state dispute settlement, or ISDS, the groups found.

The system, written into many trade and investment treaties, lets foreign investors sue governments in private tribunals, outside national courts, when new laws or regulations threaten their business. German utility RWE, for example, sued the Netherlands over its plan to phase out coal power by 2030, and British oil firm Rockhopper sued Italy after it banned new offshore drilling, according to Inside Climate News.

“As governments across the world start to adopt measures to halt climate change,” the groups said, “oil, gas and coal companies have become the biggest users of obscure legal tribunals, hidden in trade and investment deals, to bypass national court systems and sue governments over laws and regulations they allege damage their business interests.”

Investors can claim not only what they spent but the profits they expected to make. For example, Britain faces a £300 million claim after a court quashed permission for a coal mine in Cumbria, six times what the investor put into the project.

Fossil fuel investors have been awarded $86 billion, nearly 70% of all ISDS awards, and brought nearly half of all new cases in 2025, the analysis found.

“We know fossil fuel corporations are making a fortune out of global crises, hitting ordinary people hard,” said Nick Dearden, director of Global Justice Now. “But they are also using obscure international agreements to bully governments out of responding and drain money from the public sector.”

Image Credits: Center for International Environmental Law via bluesky, UN Climate Change/Kubilay Ciftci via flickr, CC, INGImage, Stefan Anderson/HPW.

Global incidence and deaths due to Tuberculosis (TB) have begun to decline in 2025.

After the setback due to COVID, the global burden of tuberculosis (TB) is declining once again, but five years behind the original target, according to the 2026 World TB report released by the World Health Organization (WHO) on Thursday.

Globally in 2025, the TB incidence rate was 129 new cases per 100,000 people. This was a 1.6% decline compared with 131 cases per 100,000 people in 2024.

In the decade between 2015 and 2025, TB incidence fell by 14%. While that is progress, it is far from the 50% target set by the End TB Strategy for the year 2025, and an 80% decline by the year 2030.

Progress in TB is running several years behind schedule.

Despite this, TB remains one of the leading causes of death from a single infectious agent, with a quarter of all cases concentrated in India in 2025.

The reduction in international donor funding for the infectious disease is a cause of concern, the report noted.

“In 2025, total funding for TB prevention, diagnosis, and treatment reached $6.6 billions, just 30% of the $22 billion annual target for 2027,” said Dr Tereza Kasaeva, director at the Department for HIV, TB, Hepatitis and STIs at the WHO.

Majority patients in 30 high-burden countries

Most cases are concentrated in 30 high-burden countries, with India having the largest number of cases.

Most of the people who develop TB are concentrated in 30 high-burden countries that account for 88% of all the cases globally.

The top eight countries in terms of TB cases (about two-thirds of the worldwide total) include India (about a quarter), Indonesia (10%), the Philippines (6.8%), China (6.5%), Pakistan (6.4%), Nigeria (4.9%), the Democratic Republic of the Congo (3.9%) and Bangladesh (3.7%).

Over half (54%) of those infected were men. Another 35% were women and 11% were children.

Africa and European regions registered significant progress in reducing the total number of cases, as did China and India, WHO experts said at the briefing.

TB deaths are falling, but funding cuts pose challenges

Dr Katherine Floyd, unit head for monitoring, evaluation and strategic information at the department for HIV, TB, Hepatitis and STIs at the WHO.

In 2025, around 1.13 million people died from TB, 4% less than the 1.18 million deaths in 2024 and a 35% decline from 1.74 million deaths in 2015.

This made 2025 a landmark year in which the first milestone of the End TB Strategy, originally set for 2020, was finally reached. However, the target of a 90% reduction in cases by 2030 remains distant.

WHO fears that the drop in international funding could offset the gains made in TB care, if they continue.

“There are also high TB burden countries where overall funding fell in 2025. And although there was no clear-cut negative impact on TB diagnosis, treatment and prevention in 2025, based on the data that have been reported so far, we know that impacts may be delayed, and this is something that needs ongoing attention,” said Dr Katherine Floyd, unit head for monitoring, evaluation and strategic information at the department for HIV, TB, Hepatitis and STIs at the WHO.

Some high high-burden countries have increased domestic funding to fill in the gaps, with the biggest increase being in India and Indonesia – two of the highest burden countries.

“Looking across the report as a whole, what’s quite striking is that most indicators of progress moved slowly in the right direction or were relatively stable between 2024 and 2025,” Floyd added. “This is true of epidemic trends as well as the coverage of TB diagnostic treatment and preventive interventions.”

Image Credits: Unsplash/CDC, Global TB Report 2026.

Philanthropies pledged $480 million to combat methane emissions, and Barbados’ Mia Mottley called for a route to a methane treaty at a leaders’ summit at COP31.

ANTALYA – France is rallying countries to write near-zero methane targets for oil and gas into the COP31 climate deal, as leaders at a summit on Thursday said it was time to move beyond the voluntary pledges on track to deliver little more than a third of the cuts promised under the 2021 Global Methane Pledge.

French Ecological Transition Minister Monique Barbut told the Leaders-Level Non-CO2 Greenhouse Gases Summit that COP31’s overarching decision should call on the oil and gas sector to reach near-zero methane emissions intensity by 2030 at the latest, and to end routine flaring and venting.

“We must go beyond coalitions of willing countries and mere declarations of intent,” Barbut said, proposing that every country in the room sign a short note to the Australian and Turkish COP31 presidencies calling for methane to be included in the decision. “We are ready to share a draft text to that end,” she said.

Barbut said the presidencies had confirmed plans to include methane in the decision, though they have yet to publish any details. Heike Henn, a state secretary in Germany’s environment ministry, backed recognising methane in the negotiated text but did not address France’s specific targets.

The Global Methane Pledge Ministerial, co-convened by Canada and the European Commission, in session at COP31.

Whether the text will go beyond a general mention of methane to set emissions targets, call for an end to routine flaring or urge governments to advance regulation, is currently unclear. Australian Climate Change and Energy Minister Chris Bowen, who chairs the negotiations, did not mention methane’s place in the decision when he addressed the same summit.

“We don’t know exactly what it is going to say,” Jonathan Banks, chief of programmes and advocacy at the Clean Air Task Force, a global NGO, told Health Policy Watch, adding that the likeliest outcome was a broad statement on methane’s importance rather than specific actions for oil and gas, agriculture and waste.

A Global Methane Pledge declaration released on Wednesday, calling on governments to turn commitments into “policies, regulations and investment plans,” drew just seven initial endorsers: Belgium, Canada, Germany, Indonesia, the Federated States of Micronesia, Norway and the United Kingdom.

“In a world of suffocating disasters, action on methane offers breathing space,” said Simon Stiell, executive secretary of UN Climate Change. “Seventy per cent of methane emissions in the oil and gas sector can be eliminated using existing technology, much of it at low or no net cost.”

On the agenda, off track

Mia Mottley, Prime Minister of Barbados, addresses the leaders’ methane summit at COP31.

Methane, which has caused nearly a third of global warming to date, according to UN data, barely registered as a climate issue at the turn of the millennium, Banks said. Since COP26 in Glasgow in 2021, most COP decisions have referenced the super pollutant, he said.

Over 20 years, a tonne of methane traps around 80 times more heat than a tonne of carbon dioxide. But unlike carbon dioxide, which can linger in the atmosphere for centuries, methane breaks down within about 12 years, so cutting it can quickly slow the rate of warming. UN officials call such cuts the “emergency brake” on near-term warming.

“It is the fastest lever we have to shave that peak,” said Ana Toni, Brazil’s national secretary for climate change. Despite findings from the UN Environment Programme (UNEP) that methane emissions must fall at least 25% by 2035 and 40% by 2040, “emissions are flat,” Toni said.

Waste, mostly from landfills and wastewater, accounts for about a fifth of human-caused methane emissions, according to the UN. Cutting it is a priority for the Turkish presidency, which has made zero waste and methane reduction one of 10 themes in its action agenda, the non-negotiated track where governments, businesses and cities sign up to practical initiatives.

“The issue is: can we get to a legal agreement rather than just a voluntary approach?” Barbados Prime Minister Mia Mottley told the summit, which China, the United Kingdom and Brazil co-hosted.

“We believe that the best way to force it is first and foremost by obviously an international treaty,” Mottley said. “But the structure of these negotiations do not admit of that in one go, and therefore we need to plot out carefully what is the route to an international treaty.”

Flaring at highest level since 2019

Annual changes in atmospheric CO2 and methane concentrations, 2000-2023. Chart: IEA

Methane emissions from the energy sector showed no sign of falling in 2025, the International Energy Agency (IEA) found in May. Oil producers flared, or burned off, 167 billion cubic metres of gas in 2025, the third straight annual rise and the highest level since 2019, the World Bank reported in June. That gas was worth around $54 billion.

Meanwhile, methane in the atmosphere reached a record 1,948 parts per billion in 2025, more than two and a half times pre-industrial levels, the World Meteorological Organization (WMO) found.

“The fossil fuel industry has the means, the technology, and the responsibility to cut fastest,” UN Secretary-General António Guterres told a leaders’ roundtable on zero waste and methane on Wednesday. “Yet its methane emissions are still rising while regulations are being rolled back or delayed.”

“We can see the pollution, we know who’s responsible, and we know how to stop it,” Guterres said. “Voluntary action is no longer enough.”

Nearly half a billion in new funding

Philanthropic donors pledged more than $480 million on Thursday for methane cuts in energy, agriculture and waste, and for action on black carbon, clean cooking, transport and cooling. It builds on more than $530 million delivered since the Global Methane Pledge was launched in 2021, according to UN Climate Change.

“As we heard from the Secretary-General, the time has passed for voluntary commitments,” said Christie Ulman, president of the Sequoia Climate Foundation, who announced the pledge alongside the Wellcome Trust. “We must work towards binding, funded action.”

Ulman said measures currently embedded in national climate plans would cut methane by about 11% by 2030. The Global Methane Pledge, backed by 159 countries and the European Union (EU), aims for at least 30% below 2020 levels.

Tracked finance for cutting methane fell to $5.2 billion in 2023 from $7.7 billion in 2021, according to the Climate Policy Initiative (CPI) and the Climate and Clean Air Coalition (CCAC). That is about 4% of the estimated $122 billion a year needed to meet the pledge, the analysis said.

Targets outrun results

Despite the shortfall, not every source of methane needs outside money, Banks said. Fixing leaks in oil and gas rarely does, because the gas that escapes is the product companies sell.

Finance is instead most needed in less profitable areas such as waste collection and recycling in Africa, he said, and he expects much of the philanthropic money to go into designing and implementing policy rather than infrastructure.

Less than a third of municipal waste is collected in sub-Saharan Africa, and more than 70% is dumped in the open, explained Nardos Bekele-Thomas, chief executive of the African Union Development Agency (AUDA-NEPAD).

“Half of that waste is organic: food scraps, market waste, farm residues, et cetera. And if they are left in the open dumps, it rots and releases methane,” Bekele-Thomas said. “If it’s burned in the open, it poisons the air of our cities. So in Africa, zero waste and methane are the same conversation.”

African environment ministers have committed to cut the open burning of waste by 60% by 2030 and end it by 2040, Bekele-Thomas said, while an Egyptian initiative launched at COP27 in 2022 aims to treat and recycle half of the continent’s solid waste by 2050.

“These are certainly targets,” she said. “And I say so plainly: they are not yet results.”

‘Matter of survival’

Global map of age-standardised rates of death attributable to ground-level ozone in 2021. Nearly 50% of the total deaths occurred in India. Chart: Clean AIr Fund

Methane helps form ground-level ozone, a pollutant linked to heart and lung disease that can also trigger asthma attacks. Ground-level ozone was linked to about 489,000 deaths worldwide in 2021, according to the State of Global Air report.

Full use of every available technical fix, enough to cut methane 32% below 2020 levels, would prevent more than 180,000 premature deaths and nearly 19 million tonnes of crop losses a year by 2030, UNEP and the CCAC found last year.

Ulman said the new funding for cleaner cookstoves and transport would cut toxic soot and deliver “immediate healthier air.” Around 2 billion people cook on open fires or simple stoves, a practice linked to 815,000 premature deaths a year, according to the IEA.

Cutting methane and other short-lived climate pollutants (SLCPs) is “a matter of survival,” Jess Beagley, policy lead at the Global Climate and Health Alliance, said in a statement to Health Policy Watch. Failing to invest would waste near-term chances to bring warming back below 1.5°C and to clean up the air “even within a political term,” she said.

“We know which actions need to be taken across energy, agriculture, transport and waste to reduce SLCPs,” Beagley said. “It’s time governments prioritised the interests of the people they serve over the profits of the industry lobbyists.”

Implementation is everything 

Much of the progress on methane has come from outside pressure, chiefly from the European Union, Banks said. Because the bloc buys large amounts of gas at high prices, its methane rules push exporters such as Nigeria, Ghana, Egypt and Kazakhstan to cut emissions so their exports can still be sold.

Kazakhstan has cut gas flaring by 87% since 2012, according to the World Bank. Had anyone told him two decades ago that he would be working with Kazakhstan’s government, “I’d probably say you’re crazy,” Banks said.

In the United States, which sent no official delegation to Antalya, the Environmental Protection Agency (EPA) proposed last month to scrap a programme for reporting large leaks and to relax limits on routine flaring of gas produced alongside oil.

Banks said US gas companies are likely to keep investing in methane controls despite the rollback in order to maintain access to global markets like the EU.

Yet the EU itself has proposed a one-year delay to rules requiring importers to report the methane linked to their oil and gas from January 2027. Given the bloc’s pull on exporters, Banks said, any delay in Europe matters.

“The biggest barrier is implementation,” Banks said. “I could write you the best policy in the world, but if it hasn’t been implemented, it doesn’t mean anything.”

Image Credits: Unsplash , IEA.

A nurse applies an intravenous drip to a patient in the Ebola treatment centre in Beni in the DRC.

Armed conflict is one of the biggest obstacles to containing the Ebola Bundibugyo in the Democratic Republic of Congo (DRC), warns the World Health Organization (WHO) on the eve of the outbreak’s sixth month.

Some 11,114 cases and 5,433 deaths have been confirmed, with a death rate of 48% in the DRC, since the outbreak was announced on 15 May.

Three Ebola patients and 1,000 contacts fled last week after rebels attacked the North Kivu town of Cantine-Aloya last week, WHO Director-General Dr Tedros Adhanom Ghebreyesus told heads of state this week.

Sixty-six people, including three health workers, were killed and three health facilities were burned down during the attack, which officials blamed on the Islamic extremist group, the Allied Democratic Forces (ADF).

“This appalling attack represents both a major humanitarian emergency and a significant setback to the response,” said Tedros, appealing to WHO member states to assist in keeping 

Meanwhile, another rebel group, the Front for the Reformation of the Nation (FRN) – formerly known as M23 – launched a new offensive in South Kivu last week, causing more people to flee their homes.

Halt in hostilities

“We need an urgent halt in hostilities and violence. Health workers and humanitarian teams must be able to reach affected communities safely, and patients must be able to seek care without fear,” Dr Roseline Belizaire, WHO Africa’s head of health emergencies, told a media briefing on Thursday.

She said that the violence is driving population displacement, which is “increasing the risk of further spread, particularly along major transport routes such as the Congo River”.

Earlier this week, the International Organization for Migration (IOM) reported that it had detected 71 people with Ebola by screening people on informal transit routes in the DRC that were not monitored by authorities.

An IOM assessment in Tshopo Province, which is one of the areas affected by Ebola, “identified 19 strategic river locations where additional surveillance points may be needed”, it noted. 

 However, the IOM said it is short of almost $60 million to cover a comprehensive Ebola response, including health screening and support at displacement sites and informal transit routes.

Money not reaching frontline workers

Warning that the outbreak is “out of control”, Médecins Sans Frontières (MSF) said this week that there is “a troubling disconnect between the considerable resources mobilised for the response and what is actually reaching patients, frontline workers, and communities”.

“Despite the vast amounts of money provided for the response, many frontline responders are left trying to contain the outbreak with empty hands and empty pockets,” said MSF president Dr Javid Abdelmoneim. 

“Our teams are often left speechless by the dysfunctions they witness in many areas. Six months into the response, this situation is simply unacceptable.”

One of MSF’s main concerns is the “persistent failure of the epidemiological surveillance system”.

“Despite the resources officially allocated to this critical activity, surveillance remains deeply problematic, with entire areas poorly covered or even completely neglected. Over the past month, close to two-thirds of reported Ebola-related deaths have occurred in communities rather than in treatment centres,” MSF noted.

Abdelmoneim added that only 9% of Ebola patients treated by MSF in Ituri province, the epicentre of the outbreak, had been identified as contacts by the surveillance system.

“Although community mistrust makes surveillance difficult, urgent improvements in oversight, staffing, and operational support are essential,” he stressed.

Deaths in communities

DRC health official Prof Steve Ahuka

Dr Chikwe Ihekweazu, WHO’s Assistant Director General, also noted that around 60% of Ebola deaths were reported in communities – which included private and traditional health facilities.

DRC Health Ministry official Professor Steve Ahuka said that there are many private health facilities in the DRC and people “use them massively”.

However, many deaths were taking place in these facilities, where infection control was poor as they lack isolation units.

Ahuka and Belizaire appealed for more funds to enable staff to remain in the field, particularly as the Eastern DRC was going into the rainy season, which would also make access more difficult.

Image Credits: Medecins sans Frontieres.

Members of the Coalition for Health Justice speaking with Health Policy Watch. From left: Dr Puspita Wijayanti, Dr Irma Hidayana, Prof Teddy Prasetyono and Prof Zainal Muttaqin.
Members of the Indonesian Coalition for Health Justice speaking with Health Policy Watch. From left: Dr Puspita Wijayanti, Dr Irma Hidayana, Prof Teddy Prasetyono and Prof Zainal Muttaqin.

A coalition of senior medical professors and anti-corruption watchdogs from Indonesia has formally petitioned the World Health Organization’s Executive Board to reject Indonesian Health Minister Budi Gunadi Sadikin’s candidacy for Director-General.

As health minister since 2020, Sadikin has pursued “a pattern of actions that have marginalized or penalized physicians, academics and health professionals who expressed legitimate criticism of government health policies,” the group alleged in a 12-page dossier dated 4 November, and obtained by Health Policy Watch. The seven-point appeal also alleges that under Sadikin’s governance, Indonesia has seen: 

  • “The weakening of the independence of scientific and professional medical bodies;”
  • “Increasing centralization and commercialization of the health system;”
  • “Erosion of meaningful stakeholder participation;”
  • “Serious concerns regarding the governance, oversight, transparency and benefit-sharing arrangements surrounding collection and use of genomic data;” and
  • “Policies that have contributed to widening health inequities.”

The coalition concluded that “Sadikin is not an appropriate candidate to lead the World Health Organization,” arguing his domestic governance record violates basic principles of scientific independence and administrative transparency.

The appeal, delivered to all WHO Executive Board members and Geneva diplomatic missions by the Coalition for Health Justice (Koalisi Keadilan Kesehatan), which includes a dozen civil society organizations and academic bodies, marks the first grassroots challenge to an official nominee seeking to succeed Dr Tedros Adhanom Ghebreyesus. 

Signatories include the Council of Professors of Medicine of Indonesia (MGBKI), Transparency International Indonesia, Indonesia Corruption Watch, the Center of Economic and Law Studies (Celios), and BPJS Watch.

The dossier was also sent to Indonesian President Prabowo Subianto, parliamentary leaders, the National Human Rights Commission, and the UN Special Rapporteur on the Right to Health.

Contacted by Health Policy Watch on Tuesday for a comment on the allegations, the Indonesian Ministry of Health and the Permanent Mission of Indonesia in Geneva did not respond. 

Sadikin’s campaign also declined to respond by Wednesday’s publication deadline, saying that they would deliver a reply by Thursday – which Health Policy Watch will print in full, once it is made available.

Diplomatic push meets domestic headwinds

The preliminary hearing in Indonesia’s Constitutional Court in December 2023 of a petition by five leading health professional organizations against a new law championed by Minister Budi Sadikin, which transferred authority for professional standards and training from the associations to the government.

Much of the domestic pushback to Sadikin’s candidacy lies in a 2023 omnibus health law championed by the health minister, under which key training, competency, and ethics standards previously managed by independent medical, nursing, and health worker associations were placed under a health ministry-backed Health Council and thus government oversight. 

The move triggered fierce resistance from the country’s medical establishment, sparking a protracted constitutional battle.

“The government, through the leadership of the current minister, has moved into controlling professional ethics and standards,” said Dr Teddy Prasetyono, a plastic surgeon and member of the Council of Professors of Medicine of Indonesia (MGBKI). Prasetyono, a lead signatory to the petition, and several other coalition members spoke with Health Policy Watch on Wednesday.

Professor Teddy Prasetyono, plastic surgeon and member of the Council of Professors of Medicine of Indonesia (MGBKI).
Professor Teddy Prasetyono.

“This is one of the most alarming policies we have ever faced, where disciplinary actions and ethical oversight that belong exclusively to independent professional societies have been taken over by the state.”

Meanwhile, a court-mandated deadline for the government to dismantle key elements of the centralised regulatory apparatus expires in late January 2027, coinciding directly with the WHO Executive Board’s candidate shortlisting session in Geneva

In rulings issued on 30 January 2026, Indonesia’s Constitutional Court held that the Collegia, the academic bodies that set specialist competency and training standards, must carry out their role independently. The court also ruled that the Indonesian Health Council should remain independent, answering only to the President, rather than to the health minister. 

It also limited the minister’s role in setting professional standards to administrative sign-off. That reversed many elements of the 2023 reform that Sadikin had led.

Still a formidable contender 

Indonesian Health Minister Budi Gunadi Sadikin in Geneva in May during this years' WHA.
Indonesian health minister Budi Gunadi Sadikin on the podium of the Geneva Graduate Institute in May during this year’s World Health Assembly.

Not everyone sees such reforms as a bad thing.

In many countries, professional societies wield outsized power. But in developing countries with weak health systems, that independence can sometimes be a mixed bag, reinforcing vested interests rather than public health, one longtime Geneva-based global health expert told Health Policy Watch.

“Health reforms that strengthen government leadership and bring professional societies under appropriate public oversight should be welcomed and celebrated, as the ultimate responsibility for safeguarding the health and well-being of citizens rests with the government,” observed the expert, who requested anonymity.

By anyone’s count, Sadikin remains a formidable contender backed by the support of the Indonesian state, and bolstered by major administrative achievements. 

According to some reports, Indonesian President Prabowo Subianto personally asked him to run. Subianto himself is, however, currently facing a wave of criticism over his management of the air pollution emergency that has overcome the country and broader region over the past several months. 

The Indonesian Chamber of Commerce has also reportedly mobilized to campaign for the candidacy of Sadikin, a former CEO of Indonesia’s largest bank.

During his tenure as health minister, Sadikin directed the distribution of 453 million COVID-19 vaccine doses, oversaw a reduction in childhood stunting from 24.4% in 2021 to 19.8% in 2024, and helped establish the Financial Intermediary Fund for Pandemic Prevention, Preparedness and Response, hosted by the World Bank. He is also one of the four co-chairs of the Accra Reset’s High-Level Panel on global health architecture, an initiative led by Ghana’s President John Mahama to give Global South governments a greater say in how global health is governed and financed. 

Jakarta has also recently increased voluntary contributions to the WHO, pledging $30 million in additional funding to the budget-strapped organization in July, a move celebrated by current WHO Director General Tedros Adhanom Ghebreyesus.

Unfolding environmental health disaster

Real-time wildfire locations and fire activity in Indonesia • as of November 12, 2026

Sadikin’s campaign is also unfolding against domestic and regional public backlash over Jakarta’s weak environmental health response to a months-long emergency. 

Toxic haze from wildfires in Sumatra and Borneo, driven by slash-and-burn deforestation to make way for farming, has spurred an epidemic of acute respiratory illness in the archipelago nation – with the haze spreading as far as Singapore and the Philippines. 

The crisis has also added fuel to the fire of criticism from civil society over inadequate state protection for vulnerable populations.

 

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In the months leading up to the wildfire crisis, Indonesia had also been wracked by spates of toxic air, including microplastics, wafting from burning landfills in a country where waste management is out of control. According to the UN, the country is the second-largest producer of mismanaged plastic waste after China. 

While Sadikin, as health minister, advised Indonesians to wear masks during such air pollution emergencies, his campaign has had little to say about how he, as the world’s top health official, might address the tsunami of changes sweeping across low-income countries – from air pollution and climate change to ultra-processed foods – leaving an epidemic of chronic disease in their wake. 

“As health minister, my job is to fix the downstream side at the end of the tunnel,”  he told Health Policy Watch in an interview last month. 

Court overturns doctor’s removal amid faculty revolt

Dr Piprim Basarah Yanuarso, thrown out of his post at a leading Jakarta hospital after he criticized new government measures, tells his story to the media.

The coalition argues that member states must evaluate Sadikin’s administrative track record alongside his lack of clinical credentials and contentious domestic methods that have landed the health ministry in the country’s highest courts over its treatment of dissenting medical leaders.

Senior clinicians and heads of professional associations report intense personal and professional pressure. In one such case, Dr Piprim Basarah Yanuarso, president of the Indonesian Paediatric Society, was reassigned by the Health Ministry from his post as paediatric cardiologist at Indonesia’s national referral hospital, Dr Cipto Mangunkusumo National General Hospital in Jakarta, to Fatmawati General Hospital.

The transfer came after Yanuarso consistently opposed government moves to place the independent medical collegium under direct ministerial control. Yanuarso was then terminated after he refused to take up the new post.

The Indonesian Supreme Court later annulled the ministerial transfer decree in September. Government officials have argued, however, that the Supreme Court ruling applies only to the initial reassignment order, while Yanuarso’s subsequent civil service termination, due to 28 consecutive days of absence from the new post, still stands.

Coalition alleges broader pattern of retaliation

372 Indonesian Professors of Medicine Deliver Statement on National Health Governance Policies on 12 June 2025.

Yanuarso’s case reflects a broader pattern of government retaliation against medical professionals and other healthcare workers who have criticized Sadikin or the Ministry, coalition members argued in their interview with Health Policy Watch.

The country’s five leading professional associations – the Indonesian Medical Association (IDI), the Indonesian National Nurses Association (PPNI), the Indonesian Dental Association (PDGI), the Indonesian Midwives Association (IBI), and the Indonesian Pharmacists Association (IAI) – had fiercely opposed the 2023 reforms from the outset. In a collective challenge to the new law in Indonesia’s Constitutional Court, they contended that the omnibus law dismantled the country’s architecture of professional independence and self-regulation.

When the Constitutional Court upheld the initial legislation in early 2024, the legal battle shifted to fresh legal challenges against its provisions on medical councils and collegia and an escalating faculty rebellion. 

The tensions escalated sharply in June 2025, when 372 medical professors issued a joint declaration of no confidence after Sadikin bypassed university faculties to launch hospital-based specialist training under ministry control.

The January 2026 Constitutional Court ruling was more favourable to the professional associations, preserving the independent role of the collegia to establish and oversee specialist competency and training standards. Health ministry officials have meanwhile maintained that senior faculty had refused repeated invitations to resolve curriculum standards through dialogue.

Major professional associations stay on the sidelines

Puspita Wijayanti, a physician and representative of the Coalition for Health Justice.
Dr Puspita Wijayanti, Coalition for Health Justice.

Notably, two frontline associations that led the 2023 constitutional challenge – the Indonesian Medical Association and the Indonesian National Nurses Association – did not sign the current appeal against Sadikin’s WHO candidacy.

Coalition leaders claim that established professional bodies have been cowed into silence after being stripped of many of their statutory authorities.

“We are fully aware that speaking publicly carries professional risks, especially for those working within the public healthcare system,” said Dr Puspita Wijayanti, a physician and coalition representative, in an interview with Health Policy Watch. 

“But we believe that remaining silent carries a greater risk, particularly for patients and healthcare workers whose concerns are not being heard.”

Indonesia’s genomic initiative and Geneva’s pathogen access and benefit sharing 

BGSI promoting the initiative on LinkedIn

Beyond domestic courtroom battles, Sadikin’s opponents say their petition also has relevance to the negotiations underway in Geneva over the proposed Pathogen Access and Benefit Sharing (PABS) Annex to the WHO Pandemic Agreement, currently deadlocked in negotiations between developed and developing nations. 

Under Sadikin’s tenure as health minister, Indonesia launched the Biomedical and Genome Science Initiative (BGSi). The mission aims to integrate genomic sequencing, biobanking, and clinical registries into routine public health and precision medicine across Indonesia. 

However, his civil society critics argue that the initiative massively expanded genomic sample collection in collaboration with a number of multinational health and tech companies, without sufficient statutory guardrails governing data ownership or benefit-sharing from health products produced using the vast data repositories. 

The companies collaborating in the initiative include BGI Group, a China-based genomics company, the UK-based Oxford Nanopore Technologies, a sequencing technology firm, G42 Healthcare, an Abu Dhabi-based AI and cloud health technology company, and the US-based gene-sequencing entity Illumina.

The Ministry of Health has in the past countered the criticism, stating that BGSi sequencing and analysis are carried out in Indonesia, that no samples are sent abroad, and that genomic data is stored in cooperation with the National Cyber and Crypto Agency (BSSN). 

Commercial hospital targets draw fire

While Sadikin is being widely hailed as a financial expert capable of steering the WHO through stormy fiscal waters, the petition challenges his market-oriented approach to public health financing. A 2024 ministry directive imposed corporate performance metrics on public referral hospitals, requiring state facilities to develop revenue targets and generate a revenue surplus, where possible.

“His target was creating all the hospitals not for servicing the people’s health, but as revenue centres, forcing hospital directors to meet targeted incomes or face being fired. It is changing public hospitals into private businesses, using sick people as the objects of business,” said Zainal Muttaqin, a senior neurosurgeon and prominent coalition member whose hospital contract was terminated after criticising ministry policies, in Wednesday’s interview with Health Policy Watch.

Sadikin has defended the targets as fiscal pragmatism, arguing that private executive wards generate commercial revenue needed to cross-subsidise universal healthcare patients under the national insurance scheme (BPJS Kesehatan).

Patient advocacy groups counter that the push to commercialise public healthcare services has strained frontline care. The coalition cites the death of a patient following an eight-hour wait for an inpatient bed. At the time of that event, Sadikin publicly conceded he felt he had failed.

The dispute also extends to drug affordability. While Sadikin publicly acknowledged that domestic retail medicine prices run up to six times higher than international benchmarks, he said in June that prices could rise by 10% to 20% this year because of the weakened rupiah, the local currency.

The coalition argues these commercial policies, alongside broader lapses in emergency coordination, conflict directly with WHO’s foundational commitment to universal and equitable healthcare access.

Contest turns on two conflicting views of Sadikin’s tenure 

The WHO Executive Board meeting in 2025. The next EB meeting in January 2027 will select the three finalists for the WHO Director General for the World Health Assembly election in May.

The civil society petition culminates in a direct challenge to Sadikin’s eligibility under WHO criteria, arguing his non-medical background and courtroom defeats disqualify him from global public health leadership. Sadikin has consistently dismissed that critique, pointing to his executive management of more than 100,000 personnel and his willingness to confront institutional resistance as proof of decisive capability.

Having received no formal acknowledgement from Jakarta or Geneva, the coalition confirmed to Health Policy Watch that it is escalating its campaign ahead of January. 

Planned steps include lobbying foreign ambassadors in Jakarta, requesting an urgent intervention from the UN Special Rapporteur on the Right to Health, and appealing directly to Dr Tedros to press for institutional engagement – even though the Director-General holds no constitutional authority over the member-state-led election process.

“If frontline professionals are afraid to speak, policymakers will never hear where the system is failing,” Wijayanti emphasised. “A future WHO Director-General must be able to listen to the people who see the failures of a health system first: healthcare workers and their patients.”

Ultimately, the contest turns on two conflicting views of Sadikin’s tenure as health minister: a necessary disruption of an entrenched medical guild during a doctor shortage, or an executive overreach that alienated the health workforce.

“Whoever leads WHO next will inherit a global health agenda that cannot be delivered without a strong, valued health workforce,” Howard Catton, chief executive of the International Council of Nurses – which represents more than 30 million nurses worldwide – told Health Policy Watch. 

Emphasising that frontline workers must be treated as “equal partners,” Catton warned that clinical trust requires “safeguarding professional ethics and ensuring health professionals can raise concerns about patient safety without fear of reprisal.”

For Board members reviewing Sadikin’s candidacy in January, the question is whether his executive track record represents decisive reform or a breach of the consultative leadership required of WHO’s top diplomat.

See more about the WHO DG election on our microsite:

WHO DG Elections 2027

Image Credits: WHO, Felix Sassmannshausen/HPW, MKRI/Ilham W.M./Indonesia Constitutional Court , IQAIR, Devandra Abi Prasetyo/Detikcom , LinkedIn/BGSI.

“Starting next year, I will no longer be Secretary-General. But you can count on this. I will not stop telling the truth, and I will not stop fighting for it,” Guterres told COP31.

ANTALYA – In his last climate summit address as UN secretary-general, António Guterres accused fossil fuel interests of “making a killing while killing our planet”, and warned that a world set to blow past 1.5°C of warming was on a “path to mutually assured destruction.”

“Fossil fuels must go the way of the dinosaurs,” Guterres told the leaders. “But that won’t happen on its own. The dinosaurs did not have a lobby. But fossil fuels do.”

The nine largest oil companies made $95 billion in profit last quarter alone, he noted, while the fund launched at COP28 in Dubai in 2023 to pay for losses from climate disasters has received around $600 million, roughly what those companies earn in 14 hours.

“The brutal truth is that the climate crisis is outrunning us,” Guterres said. “It’s time for governments to tax these windfall profits and use them to help vulnerable countries recover. Polluters must pay.”

Speaking as more than 70 world leaders gathered in Antalya for two days of speeches, Guterres appealed for unity at a time of deep divisions over war, debt and who should pay for the costs of a warming planet.

“We do not need countries to agree on everything,” Guterres said. “But we do need to cooperate on the things no country can solve alone, and the climate process itself must evolve. Negotiations matter, but success must be measured on the ground.”

Leaders of the three biggest emitters stay home

Brazilian President Luiz Inácio Lula da Silva told the summit governments are “talking more about weapons and tariffs than the survival of future generations.”

The leaders’ summit marks the point where COP31 turns from procedural wrangling to politics, before the talks close on 20 November. After a year dominated by war, inflation and an oil price shock, the path to a true breakthrough in Antalya looks steep.

“Chaos in global energy markets and climate disasters are supercharging inflation,” UN climate chief Simon Stiell told leaders. “The political costs of fossil fuel dependency are unforgiving.”

A procession of heads of state, from Australian Prime Minister Anthony Albanese to European Commission President Ursula von der Leyen, accepted that warming can no longer be held below the Paris Agreement’s 1.5°C limit, the north star of COP negotiations for the past decade.

Despite the accelerating crisis, heads of state from many of the world’s largest economies – and the three top emitters in China, India and the US – are skipping the summit.

Leaders who stayed home included China’s Xi Jinping and India’s Narendra Modi, as well as France’s Emmanuel Macron and Germany’s Friedrich Merz. The United States, the second-largest emitter, sent no official delegation for the second year running.

“It is a disgrace that only one G7 head of state and a handful of G20 leaders are attending the summit,” said Mohamed Adow, director of the Nairobi-based think tank Power Shift Africa. “The world’s biggest economies should be leading the response to the climate crisis, not leaving it to others.”

A White House official told Spectrum News the summit “rejects reality by failing to acknowledge that extremist climate policies are destroying countries around the world.”

“This concern turned into silence,” Brazilian President Luiz Inácio Lula da Silva said of climate’s place at G7 and G20 summits. “We started talking more about weapons and tariffs than the survival of future generations.”

‘Fight harder’

The window to hold global warming below 1.5ºC has closed, and greenhouse gas emissions must nearly halve within a decade to keep the chance of limiting peak warming to 1.8C in reach, the UN Environment Programme said ahead of COP31.

“Science tells us an overshoot above [1.5°C] is now inevitable,” Guterres said. “But science is not telling us to surrender. It’s telling us to fight harder. The truth is that we have the power to determine how high, how long and how devastating that overshoot will be.”

The World Meteorological Organization put the global average temperature from January to September at 1.47°C above pre-industrial levels in its latest update. An El Niño forecast to reach record strength by December will push that higher, giving a “new meaning to the phrase off the charts,” WMO Secretary-General Celeste Saulo said on Monday.

Hilda Heine, president of the Marshall Islands, whose atolls average about two metres above sea level, told leaders the global response to overshoot must be “overwhelming, or the world we know is over.”

“Overshoot means waves eating away our shores, flooding that destroys towns, schools, hospitals,” she said. “In July, I went to my home island. I saw coral, bright and lush beneath the water, as it has been throughout my life. I returned just a few months later, to find half [of it] white from bleaching.”

Most countries want the Intergovernmental Panel on Climate Change (IPCC), the UN body that assesses climate science, to finish its next reports in time for the 2028 global review of climate progress, known as the global stocktake. Oil exporters Saudi Arabia and Russia have pushed back, along with India.

“We have seen efforts to undermine the IPCC and to [block] its reports informing the next global stocktake,” Heine said. “Our Pacific scientists tell us the work can and should be completed on time.”

Trillion-dollar hurdle 

Ethiopian Prime Minister Abiy Ahmed addressing the COP31 plenary.

“Developing countries pay nearly $1 trillion in interest on public debt,” said Ethiopian Prime Minister Abiy Ahmed, whose country hosts COP32 next year. “[Early action] should begin here, with every pledge of finance answering three questions: how much, by when, on what terms.”

The UN trade and development agency, UNCTAD, puts the 2025 bill for developing nation interest payments at $995 billion and counts 3.7 billion people living in countries that spend more on interest than on either health or education.

Australian Climate Change and Energy Minister Chris Bowen, who is leading the negotiations, told leaders that just 0.2% of climate finance goes to small island developing states to help them adapt to climate change. “This must change,” he said.

“We cannot demand that countries transform their economies while denying them the means to do so,” Guterres said. “Emerging and developing economies outside China are home to nearly two-thirds of humanity, yet they receive less than one-fifth of global clean-energy investment.”

Stiell said the talks would focus on “delivering, and improving access to finance – without reopening previous agreements,” leaving untouched the Baku target. Developing countries went into the 2024 talks in Baku seeking $1.3 trillion a year and left with a pledge under which developed countries agreed to mobilise $300 billion a year by 2035. The latest OECD figures show they provided and mobilised $136.7 billion in 2024, less than half that sum.

On opening day, developing countries won a dedicated agenda item on whether rich nations are meeting their legal duty to provide finance, over EU objections.

The dinosaur lobby is in the room

“Their strategy is simple,” Guterres said of the fossil fuel lobby. “Distort the science. Delay the policy. Delay the action. Delay the accountability.”

On Monday, the day COP31 opened, Turkish President Recep Tayyip Erdoğan announced that Türkiye’s Gabar region now produces about 84,000 barrels of oil a day from 184 wells, and unveiled two new fields. Türkiye’s emissions rose by 24.4 million tonnes in 2025, the second-largest increase of any country after the United States, UNEP reported last month.

“Every new oil well drilled, every piece of coal extracted, is a threat to my country’s future,” Heine said. “The discovery of new fossil fuel resources is not something to celebrate, but something to fear.”

The presidency’s flagship pledge, to raise electricity’s share of global energy use to 35% by 2035, does not require that extra power to come from clean sources. “Electrification is important,” Heine added, “but must be linked to renewable generation.”

In a fiery address in which the Turkish president declared that “unnecessarily cutting down a healthy tree is, in fact, equal to killing a person”, Erdoğan told leaders that developed countries “that have historically consumed the global carbon budget should assume greater responsibility for emissions reductions and financing,” reopening one of the oldest fault lines in climate talks: who counts as a donor.

No new donors 

Russia’s COP31 pavilion showcasing the power of its nuclear-powered icebreaker fleet.

The 1992 UN climate convention puts the duty to provide climate finance on a list of wealthy nations known as Annex II: the United States, Japan, Germany and 20 other countries that belonged to the OECD in 1992, plus the European Union.

Russia, China and the Gulf states were never on the Annex II list. Despite decades of growth that have made China the world’s second-largest economy and Qatar and the United Arab Emirates among the richest countries per person, they insist they are not donors and will not become ones.

The Paris Agreement only encourages other countries to contribute voluntarily, which some do on their own terms: China says it has provided and mobilized more than 177 billion yuan, about $24.5 billion, for other developing countries since 2016, and the UAE launched a $30 billion climate investment fund when it hosted the 2023 summit in Dubai.

In an interview with Russian state media Interfax before the summit, Russia’s top climate envoy drew a red line reflecting non-donor states’ attitude.

“There are issues, if not ‘red lines,’ that we do not support,” Ruslan Edelgeriev, President Vladimir Putin’s special representative for climate, said. “The first is the rapid abandonment of hydrocarbons. The second issue is that they are trying to force Russia to become a ‘donor’ … we are not donors; this is purely voluntary.”

At Russia’s pavilion, an exhibit on its fleet of nuclear-powered icebreakers showcases how the country stands to profit from a warming planet, as melting sea ice opens the Northern Sea Route, an Arctic shortcut to Asia.

Russia’s long-term climate strategy, filed with the UN, says climate change “creates new opportunities” for the country’s trade and economy, including “an increase in the navigation period” on the route.

Image Credits: UNFCCC.

Former US Secretary of State John Kerry, who signed the Paris Agreement for the United States, speaks at COP31 in Antalya on Tuesday.

ANTALYA – In a tale of America at a crossroads, former US Secretary of State John Kerry declared at COP31 on Tuesday that the country would soon return to a leadership role in the global response to the climate crisis, as a new report found President Donald Trump’s war on Iran had inadvertently tipped global fossil fuel emissions into decline.

“After two years of pulling back from international cooperation, after attacking clean energy and weakening our climate [protections], especially the [Environmental Protection Agency], after mocking renewables and showing scorn for science,” Kerry said.

“The US election offers powerful proof that, given a choice between denial and delay on the one side and innovation and common sense on the other, Americans are committed to taking back their future, and we will build and rebuild our partnerships as we do that.”

Soaring oil prices and the closure of the Strait of Hormuz are set to push global emissions from coal, oil and gas down 0.4% this year, to 38.2 billion tonnes of carbon dioxide (CO2), according to the annual Global Carbon Budget report, compiled by more than 140 scientists and presented at COP31. It is the first drop since the COVID-19 pandemic, led by a 1.9% fall in emissions from oil.

IEA forecasts for 2026 have swung from a 281 million tonne rise in global fossil fuel CO2 emissions before the Iran war to a 191 million tonne fall, as sharp cuts in oil and gas demand outweigh a rebound in coal. Source: Carbon Brief analysis of IEA forecasts.

“The price of petrol and supply chain disruptions are clearly a cause of the decrease in global fossil CO2 emissions in 2026,” said Corinne Le Quéré of the University of East Anglia, who led a companion study published in Nature Climate Change.

Adding to the irony, the war waged by the president who took the US out of the Paris Agreement is also speeding the world’s turn away from fossil fuels. With the world in its second war-driven oil shock in under five years, after Russia invaded Ukraine, energy security has overtaken environmental concern as the main driver of renewables growth, the International Energy Agency (IEA) found last week.

“No country can block the sun from shining. No one can block any wind from blowing,” Kerry said. “Clean energy is not just a climate strategy; it is a national security strategy, an economic strategy, and a way to give countries much greater control over their own futures.”

The blue wave reaches Antalya

John Kerry and UN Secretary-General Antonio Guterres exchange words at COP31.

New optimism around the future political direction of the United States follows a sweeping Democratic victory in last week’s midterm elections, in which the party took both chambers of Congress and won races in long-time Republican strongholds including Texas, Kansas, Iowa and Ohio.

That same victory has inspired hope for renewed focus on health and environmental regulation gutted under the Trump administration. Democrats have pledged to restore withheld research funding, repeal deep Medicaid cuts and call in Environmental Protection Agency chief Lee Zeldin for questioning over the rollback of pollution rules, Health Policy Watch reported on Monday.

For now, the US is not in the room in Antalya. Washington formally left the Paris Agreement in January, has sent no official delegation to a COP for the second year running, and in February will become the first country ever to quit the UN climate convention itself. In 2025, Trump’s first year back in office, the US posted the largest emissions increase of any country, the UN Environment Programme found last month.

Anyone who still calls climate change a hoax, Kerry said, “should not be serving in public office.”

A dip, not a peak

The US posted the largest emissions increase of any country in 2025, adding 133 million tonnes of CO2 equivalent as electricity demand, driven in part by mass data centre expansion to fuel the AI boom, rose and coal power rebounded, with the Trump administration using emergency orders to delay coal plant closures.

Yet the Iran war was not the only factor in dropping fossil fuel emissions, and the dip may not last, scientists behind the report warned.

Solar, wind and electric vehicles met about two-thirds of this year’s rise in energy demand, Le Quéré said, with the oil shock accounting for the rest. Total CO2 emissions still rose, from 42.8 billion to 43.3 billion tonnes, as peat fires and forest degradation in Southeast Asia drove up emissions from land use.

“A decline in fossil CO2 emissions is encouraging,” said Pierre Friedlingstein of the University of Exeter, who led the study. “But a reduction driven partly by geopolitical shocks is not a sustainable climate solution.”

The world can emit just 150 billion more tonnes of CO2 before warming passes 1.5°C, less than four years of emissions at current rates. Holding the 1.5C line would mean taking emissions to zero within a decade, Friedlingstein told reporters, “which is extremely unlikely to happen.”

Kerry, who signed the Paris Agreement as secretary of state and later served as President Joe Biden’s special envoy for climate, conceded that the world had agreed “1.5 degrees was the target, and we have not delivered.”

“This is what makes it so damn frustrating,” Kerry said. “Solving this challenge is not a mystery. We know what to do.”

‘A second round of suffering’

Least Developed Countries Group chair Ambassador Adão Soares Barbosa of Timor-Leste addresses reporters on Tuesday.

The people paying for that failure live in the 44 least developed countries (LDCs), which have done the least to cause the crisis.

“For the LDCs, 1.5 is not just a number,” Ambassador Adão Soares Barbosa of Timor-Leste, who chairs the group, told reporters in Antalya. “Every fraction increase imposes a greater threat to our people’s homes, livelihoods, food and water security, and ability to recover from disasters.”

At a press conference setting out the bloc’s demands for COP31, Barbosa said the LDCs back Türkiye’s flagship 35% electrification target by 2035 but cannot reach it without money, technology and training from developed countries.

“That target is clear,” he said. “But then, how can we move together?” The biggest emitters must move off fossil fuels first, Barbosa said, and any support for LDCs must come as grants.

Repayments on climate loans to developing countries nearly tripled between 2020 and 2024 and could overtake new lending by 2036 if lending stays at current levels, a CARE analysis found. Some 3 billion people already live in countries whose governments spend more on debt interest than on health and education combined, according to the UN.

“It’s not loans,” he told reporters. “If we have loans… we will lose something. We don’t want to have a second round of suffering.”

Fossil fuels off the COP agenda

Delegates gather for the opening ceremony of COP31.

Three years after nearly 200 countries agreed in Dubai to transition away from fossil fuels, the issue is not formally on the agenda in Antalya.

Co-hosts Türkiye and Australia deliberately left it off after the fight over a fossil fuel roadmap torpedoed last year’s talks in Belém, Brazil, instead staking the summit instead on voluntary targets for electrification, waste and building efficiency.

On Tuesday, Brazil’s COP30 presidency tried to put the issue back before governments, presenting a voluntary roadmap for transitioning away from fossil fuels that it drafted after Belém ended without one.

The document is a toolkit rather than a plan, setting no deadlines or targets, leaving each country to assess its own dependence on coal, oil and gas and choose from a menu of measures. Those include scrapping fossil fuel subsidies and halting new fossil fuel power plants to cutting the flaring and venting of gas at oil and gas sites.

The transition away from fossil fuels, the roadmap concludes, is “urgent, inevitable and yet possible.”

No new backers were announced, and some fossil fuel producers are expected to resist any mention of the roadmap in the summit’s final decision.

“We have to make sure that we really do a roadmap,” Kerry said, “and we’ll find all kinds of ways to pressure and pull those CEOs to the table who are slow to move their companies.”

Host Türkiye charts path to more fossil fuels

COP31 President Murat Kurum of Türkiye addresses the plenary.

The host, meanwhile, is heading the other way. On opening day, President Recep Tayyip Erdoğan announced two new oil fields in Türkiye’s southeastern Gabar region holding an estimated 135 million barrels. State oil company TPAO is projected to nearly triple its gas output by 2035, according to a Global Witness analysis.

“The message from Türkiye could not be more contradictory,” said Jeni Miller, executive director of the Global Climate and Health Alliance, a network of more than 300 health organisations. “How can a country host the world’s most important climate conference… and on the same day announce plans to expand production of the fossil fuels driving that crisis?”

Türkiye’s flagship electrification pledge, championed by the presidency at Tuesday’s Electrification Forum, calls for lifting electricity’s share of final energy use from about 23% to 35% by 2035, but sets no requirement that the extra power be clean. Coal supplied 34% of Türkiye’s own electricity last year, according to the energy think tank Ember. Electrification “only limits overshoot if the electricity is cleanly generated,” said Samuel Guéret of Climate Analytics, a Berlin-based climate science and policy institute.

The EU, which co-hosted the first Electrification Forum on Tuesday, wants the target at the heart of the summit’s outcome but frames its own push as “clean electrification.”

“Expectations are low,” EU climate chief Wopke Hoekstra told reporters on Tuesday, pointing to a string of “underwhelming” COPs. “That’s just a reflection of reality.”

No list of backers has been published, and none is expected this week, Climate Home News reported. India has said it will not sign.

“We think this is not yet [the peak],” Le Quéré said of this year’s dip, “but the further acceleration of renewable energy and electric vehicle deployment is needed to really secure… a peak and decline afterwards.”

Image Credits: UNFCCC, UNFCCC, UNFCCC.