South Africa hosting the Third Working Group meeting of G20 Health Ministers in May virtually. The fourth meeting, in Limpopo, concluded Friday.

The United States, backed by Argentina, was reportedly blocking the G20 consensus on the final G20 Health Ministers’ statement – following their fourth and final working group meeting of the year Friday in Limpopo, South Africa, Health Policy Watch has learned. 

In a visible snub to the rest of the group, the US delegation also walked out of the meeting shortly after delivering their opening statement as part of the “Troika” of past, present and upcoming presidents of the Group of 20 annual meetings.  The G20 group of the world’s leading economic players, includes the European Union as well as 19 other nations, accounting for 85% of the world’s economic output and 75% of trade. 

The US is scheduled to host the G20 talks in 2026, while Brazil hosted the meeting last year. 

Rather than a ministerial declaration, approved by consensus, an “Outcome document and Chair’s Statement” was due to be released by the G20 group, sources told Health Policy Watch on Friday evening.  

Statements on climate and multilateral cooperation on pandemic prevention 

The draft statement, seen by Health Policy Watch on the G20 letterhead, includes key references to prioritising universal health coverage (UHC) through primary health care systems; investments in health financing and health protection (e.g. insurance) systems; investments in the health workforce; as well as initiatives to combat noncommunicable diseases (NCDs) and antimicrobial resistance.  

However, the statement also stresses multilateral action on climate change as well as pandemic prevention, preparedness and response (PPPR) – to which the US Administration of President Donald Trump is vocally opposed. 

“The recently adopted WHO Pandemic Agreement presents an opportunity to strengthen PPPR with equity at its centre and in line with the principles of sovereignty, solidarity, respect for human rights and inclusivity,” according to the draft Outcome and Chair’s statement, seen by Health Policy Watch. The statement had not yet been published on the Health Track of the G-20 website, at the time of this publication. 

At the same time that the United States withdrew from the WHO, US officials also  repudiated the Pandemic Agreement, framing it as an assault on nations’ sovereignty. The agreement, which took over two years to negotiate, was finally approved by WHO member states in May.

The Outcome statement also stresses the importance of a “timely conclusion of the negotiations on the Pathogen Access and Benefit Sharing System Annex (PABS Annex).” 

The US is reportedly planning to actively circumvent any PABS agreement with bilateral deals with countries that would condition global health aid they received to their bilateral sharing of data on pathogens with “epidemic potential.”  See related Health Policy Watch exclusive:

EXCLUSIVE: US Ties Global Health Aid to Data Sharing on Pathogens – Undermining WHO Talks

Environmental and climatic impacts on health and health systems 

Saudi Arabia led a bloc of oil-producing nations that tried to block the WHO Climate Change and Health Action Plan, in 2025, but failed.

The Outcome and Chair’s statement  also calls attention to the impacts of “environmental and climate change on global health and health systems, including human and environmental health, and its impact especially on those in vulnerable situations and developing countries.” 

It warns, in particular, of the “impact on health of harmful human activities including land-use change, pollution of air, soils and water, on ecosystems and biodiversity loss which undermine health systems’ ability to adapt and promote health resilience, these heighten the risk of zoonotic diseases and their spillovers.”

The statement also recognizes “the critical need for a coordinated, integrated, and well-resourced global response that encourages health within relevant climate action frameworks,” citing a long list of multilateral conventions and environmental agreements, beginning with the 1992 Rio Declaration, and also including the 2015 Paris Climate agreement; the 2024 G20 Health Ministerial Declaration on Climate Change, Health and Equity adopted in 2024 in Rio de Janiero, Brazil; and the 2024 WHO Climate Change and Health Resolution. A follow-up Climate Change and Health Action Plan was adopted at the May 2025 World Health Assembly after a Saudi-led effort to shelve it failed. 

Donald Trump says he won’t attend G20 Summit 

Friday’s Health Ministers’ meeting comes against the background of statements yesterday by US President Donald Trump saying that he would not attend the G20 Summit, scheduled for 23-24 November in Johannesburg. 

On Wednesday, Trump even called for the removal of South Africa from the group of economic leaders.

Speaking at an America Business Forum in Miami, Trump said South Africa shouldn’t be in the G20 – while seeming to confound South Africa with South America – saying that “for generations Miami has been a haven for those fleeing communist tyranny in South Africa.”  

Image Credits: G20.org, Health Policy Watch .

UN Secretary-General António Guterres told world leaders gathered in the Brazilian Amazon on Thursday that breaching the 1.5°C warming threshold is now unavoidable, calling the inaction on climate change a “moral failure” and “deadly negligence.”

“The hard truth is that we have failed to ensure we remain below 1.5 degrees,” Guterres said in a speech ahead of the COP30 UN Climate Conference, which begins Monday in Belém. “Science now tells us that a temporary overshoot beyond the 1.5 limit, starting at the latest in the early 2030s, is inevitable.”

The global conference in the heart of the world’s largest rainforest will open with reduced attendance; fewer than 60 world leaders confirmed their presence as compared with more than 80 at COP29 last year in Baku, Azerbaijan.

Paradigm shift needed to limit duration and magnitude of  1.5°C overshoot

Reducing emissions of methane (CH4), black carbon (BC) and other short-lived climate pollutants can reduce warming trends more rapidly. than action on CO2 sources alone

Guterres spoke of the need for a “paradigm shift” to limit the magnitude and duration of the overshoot of the landmark Paris Agreement, struck in 2015, to keep average temperatures below 1.5°C.

Now that the 1.5°C target has already been overshot for the last [12 months/year] in a row, the emphasis needs to be placed on bringing those average temperatures back down to that benchmark before the century’s end.

That, he said, can still be done through more rapid and drastic emissions cuts, a faster phase-out of fossil fuels, and reducing emissions of short-lived climate pollutants like black carbon, tropospheric ozone and methane, which persist in the atmosphere only weeks, months or years, as compared to CO2, which lingers for centuries. Increased investments in adaptation strategies are also needed to cope with current warming trends.

Studies have shown that reducing these “superpollutants” can more rapidly ‘bend the curve’ of emissions, and even lower average temperatures by as much as 0.5°C within 10-20 years. They would also lower toxic air pollution concentrations of particulates (PM2.5) and ground-level ozone, yielding massive health co-benefits.

“Let us be clear: the 1.5°C limit is a red line for humanity,” Guterres said. “It must be kept within reach.”

NDC commitments show weak political commitment

World on Track for 2.8°C Warming as Paris Agreement Overshoot Now Inevitable

National commitments would cut emissions by just 12% – less than a quarter of what is needed

Guterres’ comments follow the publication of the UN Emissions Gap Report released Tuesday, projecting the world is heading toward 2.8°C of warming by the century’s end under current policies. Only 60 of 193 countries submitted updated emissions reductions targets in their Nationally Determined Contributions by the September deadline.

If fully implemented, far from a guarantee based on climate action promises over the past decade, global emission reduction plans would cut global carbon output by just 12% by 2035, compared to 2019 levels. That’s less than a quarter of the 55% reduction by 2035 that scientists say is needed to keep the planet’s atmosphere under the 1.5°C Paris Agreement benchmark.

“Nations have had three attempts to deliver promises made under the Paris Agreement, and each time they have landed off target,” Inger Andersen, executive director of the UN Environment Programme, said this week. “While national climate plans have delivered some progress, it is nowhere near fast enough.”

In a glimmer of hope ahead of COP30, the European Union announced late Wednesday that its 27 nations agreed to a binding 2040 climate target of 90% emissions reductions from 1990 levels, setting the stage for the bloc’s position as a leader on ambition in Brazil.

“Every fraction of a degree matters in terms of lives lost, in terms of losses and damages, in terms of the risk of irreversible tipping points,” said Anne Olhoff, chief scientific editor of the UNEP Emissions Gap Report.

“The challenge has increased significantly because of the lack of action over the last five years. When we come up with the global numbers, they do not reflect how big a task this is. It’s a monstrous task. Assuming that we could just turn around the whole world, changing the entire way that the economy works overnight, is naive,” Olhoff said.

Health caught in climate crossfire

As leading emitters drag their feet on climate action, the death toll of climate inaction continues to mount.

Lancet Countdown 2025: Majority of climate and health indicators are worsening. Many have now set historic records.

Human-caused global warming claimed an estimated 546,000 lives annually from heat exposure in each of the last ten years, around one heat-related death every minute, according to the Lancet Countdown released last week.

Air pollution from fossil fuel combustion killed 2.52 million people in 2022, and contributes to nearly 8 million deaths worldwide, according to WHO figures.

Nina Renshaw, head of health at the Clean Air Fund, called the toll “an insane death spiral” in comments to Health Policy Watch.

Climate change is projected to cause up to 15.6 million annual deaths by 2050 in a business as usual scenario, yet only 0.5% of multilateral climate finance has been directed toward health sector adaptation since 2004, according to analysis released Thursday by Adelphi, a Berlin-based think tank.

Adaptation woefully underfunded

Increased investments in adaptation are urgently needed to cope with current warming trends. Along with emissions targets, that issue will also be on the agenda at COP30.

Countries have identified $2.54 billion in costed health sector needs related to national adaptation plans, but only 0.1% of that is currently covered by funding.

Broader adaptation finance requirements will exceed $310 billion annually by 2035, 12 times current flows, according to UNEP.

“Climate impacts are accelerating. Yet adaptation finance is not keeping pace, leaving the world’s most vulnerable exposed to rising seas, deadly storms, and searing heat,” Guterres said. “Adaptation is not a cost, it is a lifeline.”

The shortfall threatens the “Baku to Belém Roadmap,” a plan agreed at COP29 to scale climate finance to $300 billion from developed nations by 2035, with an aspirational target of $1.3 trillion. That total is split between investments in emissions reductions and adaptation measures, leaving the finance gap for both far off track for the real needs of countries on the frontlines of the crisis.

Fossil fuel tap says on

Likelihood of limiting warming below a specific temperature limit (%) over the twenty-first century.

Despite the accelerating crisis, direct fossil fuel subsidies reached nearly $1 trillion across 73 countries in 2023. Including indirect subsidies [such as health costs and environmental damage], the global figure rises to over $7 trillion, according to the International Monetary Fund.

With pressure on the private sector declining due to shifting political winds in nations ranging from COP30 host Brazil to the United States, companies and banks are backtracking on their own green targets. The 100 largest oil and gas companies have production strategies that would exceed their share of 1.5°C-consistent production by 189% in 2040.

“What’s still missing is political courage,” Guterres said. “Fossil fuels still command vast subsidies, taxpayers’ money. Too many corporations are making record profits from climate devastation, with billions spent on lobbying, deceiving the public and obstructing progress.”

Andersen noted the disconnect. “We are not seeing anyone reducing their oil production,” she said. “We are seeing a step up on renewables and various other things — energy efficiency, carbon capture, forestry — but actually looking at [reducing fossil fuel] production is not there.”

US denies climate data 

US President Donald Trump has called climate change a “hoax” and pulled the nation out of the Paris Agreement.

The United States withdrew from the Paris Agreement in January and is not sending any representatives to COP30. President Donald Trump told the UN General Assembly in January that climate change was “the greatest con job ever perpetrated on the world,” dismissing it as a “green scam” and calling UN predictions “nonsense.”

The US State Department inserted a disclaimer into the UNEP Emissions Gap Report stating the United States “does not support” the report. Andersen said the US even requested its data be removed. “That’s obviously impossible, because it’s one planet, one atmosphere and one impact,” she said.

Guterres laid out three imperatives for COP30: countries must agree on a credible response plan to close the emissions gap and reduce temperatures to 1.5°C, demonstrate a clear path to delivering the promised $1.3 trillion in annual climate finance, and ensure developing countries receive a “climate justice package” covering adaptation, loss and damage, and transition support.

“It’s no longer time for negotiations. It’s time for implementation, implementation and implementation,” he said.

“No one can bargain with physics,” Guterres warned. “But we can choose to lead, or be led to ruin.”

Image Credits: CCAC , Wikipedia Commons.

Luyengo Clinic in Eswatini. PEPFAR funded 80% of the clinic’s cost, but the HIV treatment of 3,000 people has been under threat since the US suspended aid in January.

The United States (US) aims to compel countries that receive its aid to fight HIV, tuberculosis and malaria to share all information about “pathogens with epidemic potential” in exchange.

This is according to a US government document, the “PEPFAR [US President’s Emergency Plan for AIDS Relief] Memorandum of Understanding (MOU) template”, seen by Health Policy Watch. 

Countries that sign these bilateral MOUs with the US will also be expected to sign a “specimen sharing agreement” committing them to sharing biological material and genetic sequence data of such pathogens with the US within five  days of detection.

An extract from the new PEPFAR MOU.

This specimen-sharing agreement is envisaged to continue for 25 years although the US aid package only runs from 2026 to 2030. However, the MOU indicates that the specimen-sharing agreement is still being drafted.

Two highly placed and credible sources have confirmed that the US is rolling out these MOUs with African countries.

These bilateral deals will potentially torpedo the Pathogen Access and Benefit Sharing (PABS) system currently being negotiated by World Health Organization (WHO) member states. The US pulled out of the WHO in January, the day Donald Trump became president.

The PABS system is the final outstanding piece of the WHO Pandemic Agreement, adopted in May after three arduous years of negotiations. 

Developing countries feel strongly that they need to benefit from any vaccines, therapeutics or diagnostics that are developed from the pathogen information that they share. The Intergovernmental Working Group (IGWG) charged with developing a PABS system that balances access to pathogen information with benefit-sharing, began text-based negotiations this week.

IGWG3 gets underway

However, the US bilateral MOU does not make any reference to countries receiving benefits from sharing their pathogen information, although they will get US support to develop disease surveillance and laboratories.

The US commits to funding “an assessment” of individual countries’ “outbreak surveillance system”, including “disease surveillance and safety procedures for pathogen sample collection, transport, storage, testing and disposal.”

The US also commits to assisting with salaries for field epidemiologists – but only for 2026. Thereafter, countries will be expected to assume responsibility for a growing percentage of these salaries over the grant period, which lasts until 2030.

The US will also fund the salaries of some laboratory technicians and 100% of laboratory commodities to identify pathogens in 2026, “subject to the availability of funds”. But funding for these lab technicians and commodities is “expected to decline gradually” after next year, according to the MOU.

Transporting pathogen specimens to labs will become countries’ responsibility after 2026.

Narrow focus

A technical guide accompanying the MOU sets out its purpose as “to establish an understanding between the US  Department of State and partner countries that will advance US interests, save lives, and help countries build resilient and durable health systems”.

The PEPFAR template is narrowly focused on nine outcomes related to HIV testing and antiretroviral treatment; reducing TB deaths and malaria deaths in children under the age of five (U5); improving maternal and U5 mortality and polio and measles vaccinations.

The MOU is heavily skewed towards disease outbreaks, and US donor recipients will be expected to have the capacity to “detect infectious disease outbreaks with epidemic or pandemic potential within seven days of emergence” and notify the US government “within one day of an infectious disease outbreak being detected”.

Once the MOUs are signed, countries can expect funds from April 2026. Several African countries are desperate for funds after their HIV treatment and care programmes were abruptly terminated or disrupted after the US declared a three-month halt to foreign aid in January. Few of these programmes have resumed fully despite US assurances that they are still supporting life-supporting programmes.

‘America first’

In September, the US State Department unveiled its America First Global Health Strategy, committing to resuming funding for HIV, tuberculosis, malaria and polio medicine and the salaries of health workers directly delivering most of these services to patients through bilateral deals with governments and faith-based organisations– at least for the 2026 financial year.

The three pillars underpinning the new strategy are to keep America safe, strong and prosperous. The long-awaited strategy clarifies how the Trump administration aims to restructure PEPFAR and replace functions of the now-defunct US Agency for International Development (USAID). 

US Secretary of State Marco Rubio described the strategy as “a positive vision for a future where we stop outbreaks before they reach our shores, enter strong bilateral agreements that promote our national interests while saving millions of lives, and help promote and export American health innovation around the world”.

Image Credits: UNAIDS.

Air pollution in New Delhi in early November 2025.

As pollution levels soar in Delhi, questions over missing data and transparency raise concerns about the government’s handling of the crisis. 

NEW DELHI – Farmers burning their fields near India’s capital city have caused air pollution in New Delhi to become even worse than it was on Diwali night, 20 October, when the extremely hazardous levels made headlines globally. 

In the past week, the share of stubble burning contributing to Delhi’s pollution had been around 2-3%, but this shot up to 22% on 6 November as farmers raced to clear their paddy fields to sow the next harvest by mid-November. 

Meanwhile, trust in air pollution data has been shaken over the past fortnight, with questions about the Delhi state government’s data collection now the subject of a case in the Supreme Court. 

Since 19 October, the PM2.5 pollution level – the key pollutant usually tracked by experts globally – in Delhi has hovered well above 120 micrograms, falling below 100 only once, while crossing 200 a couple of times. The World Health Organization (WHO) guideline is a PM2.5 average of 15 micrograms per day.  

When New York hit a record PM2.5 level of 117 micrograms on 7 June 2023, officials issued advisories to shut schools, remain indoors and wear masks, but there has been no such advisory in Delhi so far. 

High level of pollution forecast on 7 November, attributable to a surge in stubble burning (dark red) in farms north of Delhi.

Tampering with air pollution monitors?

But on Diwali night, several air monitors went blank just as pollution from firecrackers started to spike. 

A few days later, on 25 October, opposition legislator Saurabh Bharadwaj released a video showing water being sprinkled around a government-run air monitoring station in the city on Diwali night. 

Bharadwaj’s video showed trucks circling next to a top-grade air quality monitor and spraying it with water. This, he alleged, was to tamper with the data to show lower air pollution numbers.

However, the Commission for Air Quality Management (CAQM) called the allegations “factually incorrect” and “politically motivated” in a 900-word statement sent to Health Policy Watch.

CAQM says the practice is scientific and only for this particular station, Anand Vihar, where pollution is much worse than in other parts of the city.

However, another case was exposed by PeekTV reporters, who also reported that this practice started during the tenure of the earlier government led by Bharadwaj’s party, Aam Admi Party (AAP), but did not specify when or where. 

Last week, Delhi Chief Minister Rekha Gupta also attacked AAP and said air pollution data cannot be manipulated. 

A government water truck spraying an air quality monitoring station with water.

However, there are now suspicions that government data may also under-report the impact of stubble farm fires in states north of Delhi. 

AQ monitors on the blink

Significant data gaps were established on the night of Diwali when Delhi typically sees spikes in PM2.5 levels because of firecrackers. Late that night, around 30 of the 39 monitors stopped reporting continuous data. Only nine worked continuously, the Supreme Court was informed. 

Many air quality monitors didn’t work when most needed: 

PM2.5 rose to 1,763 micrograms/cubic metre at this South Delhi monitoring station on Diwali night. Soon after this level was reached, it stopped reporting data, as did several other such monitors in Delhi during a huge spike in pollution.

At least one monitor recorded PM2.5 levels as high as 1,763 micrograms, before they stopped reporting data altogether. Altogether 163 hours of Diwali AQI data from the peak pollution hours are missing this year, in comparison to only 34 hours last year, a Times of India editorial noted. 

Another data gap: Stubble burning

A much larger data gap has emerged over the farm fires in three states near Delhi. Farmers usually set fire to the residual stubble of their paddy harvest. The practice continues despite being banned by the Supreme Court. Neither the central nor the state governments of Punjab, Haryana and Uttar Pradesh have been able to stop it. 

Stubble burning on 3 November 2025, at Tohana, Haryana.

The contentious part is that data from the Indian Institute of Tropical Meteorology (IITM), a government agency, shows the contribution to Delhi’s pollution of these stubble fires to be far lower than 10% until 5 November, just before the spike. 

The number of fires is declining, the CAQM says. It states that Punjab recorded 2,518 fire counts this year as compared to 4,132 fire counts in 2024. Similarly, in Haryana 145 fire counts were recorded this year as compared to 857 in 2024. 

But other data seems to contradict this, suggesting that the stubble fires are indeed polluting Delhi and the rest of north India. 

In fact, there are 25% and 33% more fires this year than in 2020 and 2024, according to Hiren Jethva, a scientist at NASA. 

Jethva told HPW that IITM model projections are based on NASA/NOAA satellite fire detection, which miss the late afternoon burning. Last year, he showed Health Policy Watch that farmers had worked out how to evade the satellite imagery used by officials by starting the fires after the satellite completes its pass. 

The other contradiction, according to a Delhi-based senior air quality researcher who spoke with HPW, is the amount of carbon monoxide (CO) in Delhi’s air.

The chart below, shared by the researcher, shows spikes in CO levels in April-May and October-November, when crop residue is burnt in the northern states. The latest data show a spike this time of year as well. 

Adding to the controversy, the Delhi government went ahead with cloud seeding flights to try to start rain on 28 October despite warnings from the Indian Meteorological Department that there was insufficient cloud or moisture in the atmosphere to result in rain, according to The Hindu.

What the government has not tried yet is curbs on vehicle emissions, except on some types of trucks and vans from outside Delhi. Vehicular pollution in Delhi has been around 15-20% in the last few days, according to IITM. 

Lack of trust

As many as 87% of Delhi residents reportedly do not trust air quality data from the government’s monitors, a post-Diwali survey found. Governments have invested in monitors, systems, scientists, and research but data transparency and communication remain poor given the magnitude of the crisis – and the outrage. 

Restoring trust will require more than just PR and top-down statements.

Meanwhile, local doctors point out the damage they see in patients as a result of air pollution, and at least one has advised residents to leave the national capital for six to eight weeks if they can afford it. 

Dr Naresh Trehan, a renowned cardiologist at Medanta Hospital, says they see blackened lungs every day in heart operations. 

“Exposure to high particulate matter in the air… creates black marks around the lungs,” Trehan explained to the news agency, PTI. “Oxygen transmission across the membrane of the lung becomes obstructed. So the lack of oxygen in the blood causes damage to every organ, including the heart.” 

Image Credits: The Week, Delhi Pollution Control Board, Vidyut Mohan.

The year 2025 is on track to be among the hottest years on record, according to the latest update from WMO.

The year 2025 is set to be among the top three hottest years in the planet’s 176-year observational record, according to the State of the Global Climate Update from the World Meteorological Organization (WMO).

The mean near-surface temperature from January to August was 1.42°C (± 0.12°C) above the pre-industrial average, the report said.

Depending on what the final mean temperature would be by the end of December, 2025 is likely to end up as the second or the third warmest year on record.

WMO’s report comes days before the UN climate summit COP30, set to kick off on Monday in Brazil’s Belém, and is meant to provide evidence to anchor the climate negotiations.

“This unprecedented streak of high temperatures, combined with last year’s record increase in greenhouse gas levels, makes it clear that it will be virtually impossible to limit global warming to 1.5°C in the next few years without temporarily overshooting this target,” said WMO Secretary-General Celeste Saulo.

“But the science is equally clear that it’s still entirely possible and essential to bring temperatures back down to 1.5°C by the end of the century.”

See related story: World on Track for 2.8°C Warming as Paris Agreement Overshoot Now Inevitable

Concentrations of heat-trapping greenhouse gases and the ocean heat content, which reached record levels in 2024, have continued to rise in 2025. The past 11 years (2015-2025)  will individually have been the 11 warmest years on record.

“Each year above 1.5°C will hammer economies, deepen inequalities and inflict irreversible damage. We must act now, at great speed and scale, to make the overshoot as small, as short, and as safe as possible – and bring temperatures back below 1.5°C before the end of the century,” said UN Secretary-General António Guterres, who also cited the WMO report in his statement to the upcoming COP30, imploring countries to be more ambitious in their actions.

As temperature rise continues, Arctic and Antarctic ice hit record lows 

Global mean temperatures are set to breach the Paris agreement target of 1.5°C at least temporarily.

In 2024, the current hottest year on record, the mean near-surface temperature was 1.55°C (± 0.13 °C). It temporarily breached the 1.5°C target set by the 2015 Paris Agreement. 

The 26-month period from June 2023 to August 2025 has seen an extended streak of monthly record-breaking temperatures, with February 2025 being an exception.

WMO has attributed the global temperatures in the past three years to the transition from a prolonged La Niña that lasted from 2020 to early 2023 to El Niño conditions. In addition, reductions in aerosols and other factors have likely also played a role in increasing the warming, WMO report said.

About 90% of the excess heat in the Earth’s atmosphere goes into the oceans. As a result, ocean heat content has continued to rise in 2025, according to preliminary data, and is above the record 2024 values. 

Ice-extent in the Arctic sea in March this year was at its lowest maximum extent.

The rising temperatures have affected the ice volume at both poles.

Arctic sea-ice extent reached its annual maximum of 13.8 million km2 in March, the lowest maximum extent in the satellite record. Arctic sea-ice extent reached its annual minimum of 4.6 million km2 around 6 September, which remained below the long-term average.

Antarctic sea-ice extent was the third lowest on record, both for the annual minimum (2.1 million km2) in February 2025, and annual maximum (17.9 million km2) in September 2025.

All monitored glaciated regions around the world recorded net mass loss in the hydrological year 2023-24.

The long-term sea level rise trends continue despite a small and temporary blip due to naturally occurring factors.

Cascading impact of long-term temperatures continue

Extreme weather events like flooding, droughts, wildfires, heatwaves and tropical cyclones have occurred throughout the planet, intensified by rising temperatures.

Rising temperatures have a cascading impact on extreme weather events, such as devastating rainfall and flooding to brutal heat and wildfires.

Until August, such events contributed to displacement across multiple regions, undermining sustainable development and economic progress.

But the WMO has highlighted progress made when it comes to early warning systems. Since 2015, the number of countries reporting multi-hazard early warning systems (MHEWSs) has more than doubled – from 56 to 119 in 2024.

Nearly 40% countries still lack MHEWSs, and WMO is pushing for regional collaborations to close these gaps. This was also a key focus area at its recently concluded Congress in Geneva.



Countries are also using weather and climate data for seasonal outlooks in key sectors like agriculture, water, health and energy. Around two-thirds of countries now provide some form of climate services, varying from essential to advanced level. This number was at 35% just five years ago, WMO said.

The organisation has cautioned that, given climatic changes would influence the production of renewable energy, countries need to factor these influences to build reliable and flexible clean energy systems.

Image Credits: Unsplash/Misbahul Aulia, WMO.

UN report finds 1.5°C overshoot now ‘inevitable’ despite improvements in global emissions trajectory.

The world is heading for 2.8°C of warming by century’s end under current policies, according to a United Nations assessment released Tuesday that finds new climate pledges have “barely moved the needle” despite a decade of international commitments under the Paris Agreement.

The projection represents a decline from the 3.1°C forecast in last year’s assessment, but the UN Environment Programme warns that methodological updates account for 0.1°C of that improvement, while the US withdrawal from the Paris Agreement will erase another 0.1°C, meaning actual policy progress remains minimal.

“Nations have had three attempts to deliver promises made under the Paris Agreement, and each time they have landed off target,” said Inger Andersen, executive director of UNEP.

“While national climate plans have delivered some progress, it is nowhere near fast enough,” Andersen said. “We still need unprecedented emissions cuts in an increasingly tight window, with an increasingly challenging geopolitical backdrop.”

Even if all new climate targets submitted this year are fully implemented, they would reduce global emissions by only 12% by 2035 compared to 2019 levels, falling well short of the 55% reduction required to limit warming to 1.5°C, the Emissions Gap Report finds.

Likelihood of limiting warming below a specific temperature limit (%) over the twenty-first century.

“We are far from closing the emissions gap, far from getting on track for a 1.5-degree future, far from protecting vulnerable communities from climate catastrophe,” UN Secretary-General António Guterres said. “Continuing to invest in fossil fuels is a dead end. But the task before us remains immense.”

“Scientists tell us that a temporary overshoot above 1.5 degrees is now inevitable, starting at the latest in the early 2030s,” Guterres added. “And the path to a liveable future gets steeper by the day. But this is no reason to surrender. It’s a reason to step up and speed up.”

To limit overshoot to about 0.3°C and return to 1.5°C by 2100, emissions would need to fall 26% by 2030 and 46% by 2035 compared to 2019 levels, UNEP estimates, a finding Andersen said forces acceptance of a difficult reality.

“This situation means we must accept a hard truth: the multi-decadal average of global temperatures will exceed 1.5°C, very likely within the next decade. The task is to make this overshoot minimal and temporary.”

Every fraction counts 

Total net anthropogenic GHG emissions, 1990–2024.

Global greenhouse gas emissions rose 2.3% to a record 57.7 gigatons of CO2 equivalent in 2024, the largest annual increase since the 2000s. The rise occurred across all major sectors and greenhouse gas categories, UNEP said.

Land use change and deforestation proved decisive in driving the surge, with net emissions from this source jumping 21% and accounting for 53% of the overall increase. The rise was driven by extensive wildfires and land clearing, exacerbated by El Niño conditions that increased drought risk, particularly in South America.

Only 60 of 193 parties to the Paris Agreement submitted or announced new climate targets for 2035 by the Sept. 30 deadline, representing about 63% of global greenhouse gas emissions. The gap between these pledges and what is needed remains enormous.

“The emissions gap has narrowed compared with last year’s assessment, but it remains large,” said Anne Olhoff, the report’s chief scientific editor. “Every fraction of a degree matters in terms of lives lost, in terms of losses and damages, in terms of the risk of irreversible tipping points. So we really need to go as low as we can. The challenge has increased significantly because of the lack of action over the last five years.”

Global GHG emissions under different scenarios and the emissions gap in 2030 and 2035.

Meanwhile, fossil fuel production continues to expand in direct contradiction to climate pledges. The UN-backed Production Gap Report, released in September, found governments collectively plan to produce more than double the amount of coal, oil and gas in 2030 than would be consistent with limiting warming to 1.5°C.

The 100 largest oil and gas companies have production strategies on track to exceed their share of 1.5°C-consistent production by 189% in 2040, while private bank lending to fossil fuel activities surged 29% to $611 billion in 2024, exceeding green sector lending by 15%.

“We are not seeing anyone reducing their oil production,” Andersen said. “We are seeing step up on renewables and various other things – energy efficiency, carbon capture, forestry – but actually looking at production, is not there [in the NDCs].”

Some 73 of 87 countries reviewed in a recent Lancet report provided net explicit fossil fuel subsidies in 2023, allocating nearly $1 trillion in direct support. Including indirect subsidies, the global figure rises to over $7 trillion, according to the International Monetary Fund, more than governments spend annually on education and about two-thirds of what they spend on healthcare. Fifteen countries allocated more funds to net fossil fuel subsidies than to national health budgets in 2024, according to The Lancet. 

Total net GHG emissions by gas, sector, and fossil or non-fossil category in 2024.

Olhoff noted that the report’s calculations exclude military emissions, which remain unaccounted for under UN climate agreements due to lack of reliable data.

Studies suggest the world’s armed forces generate roughly 5.5% of total global greenhouse gas emissions — more than Russia’s entire national output — yet are exempt from mandatory reporting under both the Kyoto Protocol and Paris Agreement. Experts have called for militaries to disclose and reduce their emissions, warning that the climate impact of warfare and defence sectors is very likely growing amid a flare up in conflicts and military activity worldwide.

Despite the report’s alarming findings, officials emphasised progress since the Paris Agreement’s adoption. Global warming projections based on current policies have dropped about 1°C since 2015, and net zero pledges now cover about 70% of global emissions.

“The international community is now in a far better position to accelerate climate ambition and action than a decade ago,” said Anne Olhoff, the report’s chief scientific editor.

“When we come up with the global numbers, they do not reflect how big a task this is. It’s a monstrous task,” Olhoff said. “Assuming that we could just turn around the whole world, changing the entire way that the world works, economy works overnight, is naive.”

G20 nations fall short 

Total greenhouse gas emissions of the six largest emitters (GtCO2e).

The G20 major economies, which account for 77% of global emissions excluding the African Union, collectively failed to deliver adequate climate action. UNEP found G20 emissions rose 0.7% in 2024, with the European Union the only major emitter to record a decrease, down 2.1%. India’s emissions grew 3.6%, Indonesia 4.6%, and China 0.5%.

Only seven G20 members are likely to achieve their 2030 targets with existing policies, while nine — including Argentina, Brazil, Canada, Japan, South Korea, Saudi Arabia, the United Kingdom, and the United States — are projected to fall short, according to the report.

Nevertheless, some hopeful signals are emerging in the climate fight. One bright spot emerged in China, where updated projections show emissions peaking around 2025 — five years earlier than previously forecast — before declining through 2030. The shift reflects renewables expansion outpacing power demand as China last year surpassed the EU in cumulative historical emissions, now second only to the United States.

The European Council announced on Wednesday that it reached an agreement on a new intermediate climate target for 2040 to reduce net greenhouse gas emissions by 90% from 1990 levels.

Late Wednesday, the European Union announced its long-awaited pledge in another glimmer of hope ahead of COP30: European environment ministers agreed to set a binding 2040 climate target of 90% emissions reductions from 1990 levels. Eighty-five per cent of those cuts will come domestically, with up to 5% achieved through international offsets.

“Today we have adopted a 90 per cent climate target for 2040 with broad support from the member states,” said Lars Aagaard, Denmark’s minister for climate, energy and utilities. “The target is rooted in science and at the same time combines our competitiveness and security. Even in challenging times, we can stand united.”

The agreement positions the EU as the only major bloc still reducing emissions and taking on deeper cuts as the world searches for climate leadership in the absence of the United States, building on the EU’s previous target of reducing emissions by 66-72,5% by 2035.

“With the adoption of EU’s NDC, we are sending a strong signal ahead of COP30 that we remain fully committed to keeping the goals of the Paris Agreement,” Aagaard said. “It enables us to push for more global climate action, when we meet the rest of the world at COP30.”

US rejects UN findings

US President Donald Trump has vowed to remove the country from the Paris Agreement and void all climate commitments made by his predecessor, Joe Biden.

Across the Atlantic, climate policy winds are blowing in the complete opposite direction.

The U.S. State Department inserted a formal disclaimer into the report stating the United States “does not support the Emissions Gap Report” and that “international environmental agreements must not unduly or unfairly burden the United States.”

The department notified the UN Secretary-General of U.S. withdrawal from the Paris Agreement on Jan. 27, with the withdrawal taking effect in late January 2026. The government informed UNEP it would not provide comments on the report.

“There was a deadline by which countries we offered the opportunity to comment should have responded. The US did not make the deadline,” Andersen explained. “Subsequently, they asked for data about the United States to be removed. That’s obviously impossible, because it’s one planet, one atmosphere and one impact.”

Andersen emphasised that “the final Emissions Gap Report has absolutely not changed or been updated based on any country engagement. We accommodated the footnote for the singular reason that the U.S. has announced they are leaving the Paris accord, but the scientific evidence and the contents of the report remain completely unchanged.”

The Biden administration had set a target to cut emissions 61% to 66% below 2005 levels by 2035, but the Trump administration has vowed to eliminate those targets.

A 2.8°C future 

Trees cocooned in spiders webs after flooding in Sindh, Pakistan.

Warming of 2.8°C would fundamentally transform Earth’s climate system with severe impacts across the planet.

Hundreds of millions of people — billions by some estimates — would face displacement from coastal flooding and sea level rise. Extreme heat zones like the Sahara, currently covering less than 1% of land today, could expand to nearly 20% of Earth’s surface, potentially pushing one in three people outside climate conditions humans have inhabited for millennia.

Agricultural regions depended on for food production would become increasingly unviable, causing displacement, conflict and hunger across vast swaths of currently inhabited land. Agricultural yields would decline in many regions, while extreme drought affected a record 61% of global land area in 2024, threatening food and water security.

Parts of South Asia, the Middle East and tropical regions could experience heat and humidity combinations that exceed human survivability limits. Heat exposure already claims an estimated 546,000 lives annually, according to recent research published in The Lancet. Weather-related extreme events caused $304 billion in global economic losses in 2024, a 59% increase from the 2010-14 annual average.

“1.5 degrees by the end of the century remains our North Star,” Guterres said. “And the science is clear: this goal is still within reach. But only if we meaningfully increase our ambition.”

Markets march forward 

“There is no time left for further delay,” Andersen said.

Officials emphasised that the technologies needed for rapid emissions cuts are available and increasingly cost-competitive.

“Proven solutions already exist,” Andersen said. “From the rapid growth in cheap renewable energy to tackling methane emissions, we know what needs to be done. Now is the time for countries to go all in and invest in their future with ambitious climate action — action that delivers faster economic growth, better human health, more jobs, energy security and resilience.”

Wind and solar deployment continues to exceed expectations, with costs declining rapidly. For the first time, renewable energy sources surpassed coal as the largest source of electricity in the first half of 2025.

“The solutions needed to course correct are available at low cost, and they can deliver stronger economic growth, better human health, more jobs, energy security and resilience,” Olhoff said.

Andersen added that market forces increasingly align with climate action despite political headwinds moving against the science.

“We may see a slower uptake in some markets, in the US on the renewable side, but in other places, we will see it just accelerate as much as it has done,” Andersen said. “The renewable pricing has just completely dropped and made it very, very competitive, and actually out-competes [fossil fuels]. And of course, the jobs lie there — both in the immediate production of renewables but also in the downstream and upstream supply chains to these technologies.”

“Many investors globally, many shareholders globally, and many workers who work for these companies globally, this is what they want, and this is also what the consumer wants,” she added. “I think we will see the markets continue to march forward.”

Image Credits: Matt Howard/ Unslash, GPA Photo Archive/Flickr, UK DFID.

Dr Tlaleng Mofokeng, the United Nations Special Rapporteur on the Right to Health
Dr Tlaleng Mofokeng, the United Nations Special Rapporteur on the Right to Health (right) addresses the CeHDI event.

Sexual and reproductive health rights (SRHR) are being restricted, human rights defenders are being silenced, and evidence-based policy is being replaced by ideology – “but we are not powerless or voiceless”, said Dr Tlaleng Mofokeng, the United Nations Special Rapporteur on the Right to Health.

She urged governments and organisations to use the “right to health” approach to break down “siloes” to ensure all people have access to the health services they need. 

“There should be no competing agendas between maternal health, sexual and reproductive health rights, and universal health coverage,” she told a meeting hosted by the Centre for Health Diplomacy and Inclusion (CeHDI) on the sidelines of the International Conference on Family Planning (ICFP) on Tuesday.

“They are all part of the same promise of human dignity,” said Mofokeng. 

CeHDI CEO Haileyesus Getahun told the meeting that the right to health is enshrined in “several international laws and agreements”, primarily the International Covenant on Economic, Social and Cultural Rights which has been signed by 174 countries.

“The right to health is a gateway to universal coverage, to providing every [health] service and for anyone,” said Haileyesus.

CeHDI CEO Haileyesus Getahun and Dr Ana Luiza Caldas, Brazil’s Vice-Minister of Health

Universal right

“The right to health is universal precisely because it depends on shared resources and collective responses,” added Alison Drayton, Assistant Secretary General of the Caribbean Community, CARICOM.

“Operationalising the right to health requires systems, partnerships and accountability,” she added. “CARICOM member states are working collectively to translate rights into action. We are investing in integrated family health care, gender responsive budgeting and data systems that make inequities visible.”

Dr Ana Luiza Caldas, Brazil’s Vice-Minister of Health, said that her country has made significant progress in consolidating universal health coverage through primary health care.

For 35 years, the Brazilian health ministry has focused on strengthening its connections with communities, starting at the local council level. Its SRH services cover a wide range of contraceptive options, including free condoms at schools, said Caldas.

Never seen a condom

Ayesha Amin and Betty Herlina

Indonesian journalist Betty Herlina admitted that she had seen a condom for the first time in her life at the conference – simply because sex is not a topic for open discussion in her country.

“This is prohibited in Indonesia,” said Herlina, adding that if she displayed a condom in public, she would be branded as “too liberal”, a feminist and advocating “free love”.

“This is a bias we need to break,” she said. “We cannot teach any children about sex education, but there’s a lot of sexual harassment, especially in [religious] schools, and most of the perpetrators are ulama, our religious leaders.”

Ayesha Amin, founded Baithak, an organisation dedicated to challenging taboos in Pakistan. She works on three levels: providing safe spaces for marginalised and climate-affected girls and women to ask questions about sexual and reproductive health, encouraging their leadership and working with young men.

Her organisation has supported the formation of the Sisterhood Collective run by a network of 25 young feminist activists.

“Every time a disaster hits, these women go and demand SRHR as a non-negotiable. They demand that pregnant women have access to maternal care and safe delivery, that adolescent girls have access to WASH facilities, that women have access to dignity and safety in those flood camps,” said Amin. Pakistan is particularly vulnerable to flooding.

“Right now, the decision-making around women’s bodies and bodily autonomy in SRHR is being done by men,” said Amin. “So changing those mindsets through male engagement, enabling men to become allies, creates spaces for women in decision-making.”

Huge backlash

The ICFP, currently being hosted in Colombia, comes at a time of huge pushback against sexual and reproductive health and rights, currently led by the United States under President Donald Trump.

Aside from defunding global health programmes – from HIV to SRH – the US is pushing an anti-abortion allaince centred on the Geneva Consensus Declaration, which asserts that abortion is not a right.

On the eve of ICFP, UNFPA Executive Director Diene Keita said that “access to contraception is under threat, due to global funding shortfalls”. 

“UNFPA is seeing contraceptive stocks dwindle in communities that rely on international family planning funding,” she added.

“Health systems are bracing for a rise in unintended pregnancies, which are in turn linked to higher rates of maternal death, including due to unsafe abortion. 

“And the impacts are likely to extend far beyond health care: We can expect to see adolescent pregnancies, school dropouts, and even increased risk of gender-based violence.”

UNFPA estimates that for every $1 invested in unmet contraception needs yields $27 in economic benefits.

DAC founder George Vradenburg (right) and McKinsey’s Kana Enomoto (centre).

Some 80 million Africans are projected to have dementia by 2050 – a fourfold increase from 2015 – and governments need to invest in brain health as an “economic imperative” to mitigate this.

This call was made by the Davos Alzheimer’s Collaborative (DAC) at a meeting in Johannesburg on Tuesday, on the eve of the G20 Health Ministers meeting in South Africa.

DAC founder and board chair George Vradenburg told the meeting that it is precisely because the African population “skews young, not old” that the continent has the opportunity to prevent cognitive decline.

“Preventing Alzheimer’s, in significant part, can be achieved by taking care of the brain during the course of your life,” Vradenburg told the meeting, which was co-hosted by the Science for Africa (SFA) Foundation.

Key interventions from experts during the course of the day-long meeting highlighted the importance of nutrition – particularly during the first 1,000 days of a baby’s life – in enhancing brain health.

“The science is clear. Brain development begins in the womb, and the first 1,000 days of life shape the architecture of the brain,” said Mireille Wenger, Provincial Minister of Health and Wellness in the Western Cape province.

“Nutrition, stimulation, safety, love and support in those early months and years determine learning potential, mental resilience, social participation and economic opportunity later in life.”

Wellcome Leap’s Dr Holly Baines added that “adolescence is another critical period in terms of brain development” and emerging research actually indicates that Alzheimer’s disease might actually be a condition starting in midlife in relation to women’s health”.

“The brain undergoes these distinct critical periods, and so it’s really important for us to think about when the brain is particularly sensitive, but also malleable, to different environmental factors and interventions,” said Baines.

However, she added that scientists still don’t understand “the critical intervention windows”. 

The meeting launched Africa’s first-ever Brain Health Plan for Africa, a five-year roadmap to investing in African “brain capital” developed by 25 academics and 28 institutions.

It sets clear goals across six strategic areas, covering advocacy, the “brain economy”, harnessing data,digital and AI solutions, repurposing resources, breaking down silos and funding.

Economic dividends

Around 60% of the continent’s population is under the age of 25, and by 2030, half of all new workers in the world will come from sub-Saharan Africa, said Vradenburg. 

“To harness the potential economic and innovative potential of those workers, we must invest in their brain health – the ‘brain capital’ of Africa is dependent on the skills of creativity, problem-solving ability, and imagination so badly needed in the 21st-century job market. African competitiveness and workforce productivity are dependent on the brains of its people,” he noted.

Scaling up known interventions to address brain health conditions could add $6.2 trillion, around 3% to the global GDP, each year by 2050 – mostly by improving productivity and labour force participation, according to Kana Enomoto, director of brain health at the McKinsey Health Institute.

In contrast, a modelling study by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, found that in 2019, Africans had spent about $10 billion on direct health services related to 24 brain disorders, said IHME’s Dr Angela Apeagyei.

Dr Angela Apeagyei from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

“Millions are being spent on the development of AI, yet very little is being invested in brain health,” said Vradenburg. “The argument that we are making to the G20 governments is: invest in human intelligence with the same sense of urgency and pace that you’re investing in artificial intelligence.”

Shifting demographics

While Africa has a young population, this is shifting, warned Prof Mohamed Salama from the American University in Cairo’s Institute of Global Health and Human Ecology.

“The demographic pyramid is not going to be a pyramid by 2050, as the number of older adults is going to triple. Rather than having around 47 to 50 million older adults, we would reach 150 million,” said Salama.

“This stark increase will pose different challenges to the healthcare system, economy, politics, everything, and we need to be prepared.”

Wenger agreed, saying that the demographics in South Africa were already changing, and her province was ageing the fastest: “Planning for healthy ageing cannot begin at retirement age. It must begin much earlier with prevention, early development, nutrition; with early diagnoses, social connection and systems designed to support people throughout their lifespan.”

Harnessing digital solutions

While governments are investing an outsized amount in AI, several digital and AI tools do have the potential to help Africa.

Speakers told the meeting that chatbots speaking in various African languages could assist with the care of people with dementia. This had been piloted in Tunisia, which has only one Alzheimer’s treatment centre for the entire country, and it had both assisted people and reduced their need to travel to the centre.

AI and digital tools can also expand the early detection of cognitive problems.

Tom Kariuki, CEO of Science for Africa Foundation.

Tom Kariuki, CEO of the SFA Foundation, described brain health as “an economic and social investment that will determine how well Africa competes, innovates, and thrives”.

“Investing in brain health is investing in innovation, productivity, and resilience, the very foundations of our continent’s long-term growth,” said Kariuki.

Professor Claudio Bassetti, vice-president of the European Brain Council, said he was not aware of any country in the world that is investing significantly in the prevention of dementia and other brain disorders.

“My country [Switzerland] is investing 2% of the entire health budget in prevention, although, for example, 80% of the cost for dementia goes into nursing homes,” said Bassetti, who chairs the Lancet Commission on Brain Health.

Vradenburg said that next year, DAC aims to “get practical” about what needs to change, moving from “brain health into brain capital, the brain economy”.

DAC is trying to figure out how to address both demographics, with older populations that are going to be sicker and incur “unsustainable health costs around the world” and “artificial intelligence, which basically threatens to eliminate 90% of our jobs, which will destroy humanity”.

“We have got to figure out how to take this moment and turn it into a human brain positive economy, not just an artificial brain economy.”

Image Credits: DAC.

The third meeting of the Intergovernmental Working Group (IGWG), with text-based negotiations on the first draft of the PABS annex, gets underway in Geneva.

“Inadequate” and “unbalanced” were some of the complaints levelled against the first draft of a Pathogen Access and Benefit-Sharing (PABS) system when World Health Organization (WHO) member states met for text-based negotiations in Geneva on Monday.

Once agreed, the PABS system will be an annex to the Pandemic Agreement, but several member states at the Intergovernmental Working Group (IGWG) described the first draft as simply a “cut and paste” of text already in the agreement.

However, even before text-based negotiations began, members confronted a contentious process issue. Despite an agreement at the last IGWG meeting in September that “relevant stakeholders” would be included as observers in the negotiations as a “pilot”, it emerged that some member states had privately objected to this. 

This prompted IGWG co-chairs to call for more consultation “for a day or two” before opening the doors. 

“Not everybody is comfortable to proceed with the pilot at IGWG 3, but I do want to reassure those with concerns that we will actively talk with you as members, talk with relevant stakeholders, to find a way forward,” said an apologetic IGWG co-chair Matthew Harpur, adding that some member states were particularly uncomfortable with the drafting process being opened to stakeholders.

However, Brazil, supported by Colombia, objected to the process U-turn and called on member states with objections – reputed to be Russia and its allies – to stand up and discuss these openly.

Brazil called on member states that objected to the inclusion of stakeholders to raise their problems at IGWG.

First draft is ‘just a first draft’

WHO Director General Dr Tedros Adhanom Ghebreyesus described the draft as “a genuine attempt by the Bureau [the IGWG administration] to find as much middle ground as possible based on the input of member states and relevant stakeholders”. 

“But of course, a first draft is just a first draft, and we all know that further discussions will be needed to bring views and positions closer together,” he added, noting that only three further IGWG meetings remain until the April 2026 deadline.

“Bringing it to completion will require you all to engage in open and frank discussion and to find compromise and flexibility,” added Tedros.

There was consensus that the seven-page draft was inadequate as it does not set out in enough detail how information about pathogens with pandemic potential can be shared, and how countries sharing this information can access any vaccines, therapeutics and diagnostics (VTD) that arise from them sharing this with pharmaceutical companies.

Tunisia, speaking for the Eastern Mediterranean Region (EMRO), said that if the PABS system is to be “reliable and functional, all participants need clarity on how it will operate in practice”. 

EMRO wants the PABS annex to “establish standard material transfer agreements, as in the Pandemic Influenza Preparedness (PIP) Framework” along with terms and conditions that define the rules and responsibilities of providers, laboratories, databases and manufacturers. 

It also wants the annex to explicitly include the transfer of technology to enable different regions to produce their own VTDs.

Lack of operational detail

Indonesia, speaking for the Group of Equity.

Indonesia, representing the Group of Equity, also criticised the lack of operational detail about how the PABS system would work, and the “lack of legal certainty regarding rights and obligations” of both providers of pathogen information and users of the PABS system.

Advocating for immediate line-by-line negotiations, Indonesia called for benefit sharing that “fosters geographically diversified local production, including through non-exclusive licences to manufacturers in developing countries”. 

Zimbabwe, speaking for the WHO Africa region plus Egypt, Somalia, Sudan and Libya, described the draft as “inadequate”, asserting that “a PABS system that lacks enforceability becomes a charitable model, and charity is not equity.

“Equity cannot remain aspirational language. It must be operational, enforceable and guaranteed to avoid repeating the catastrophic inequities witnessed during the COVID-19 pandemic,” added Zimbabwe.

South Africa fleshed this criticism out, calling the draft “unbalanced” for enabling access to pathogen information without legally binding benefit-sharing terms.

While the European Union (EU) said it did not have a detailed response to the text, it warned against onerous benefit-sharing terms.

“An implementable PABS system can only encourage, as opposed to compel or coerce, stakeholders, in particular, manufacturers of vaccines, therapeutics and diagnostics, to participate by voluntarily signing legally binding PABS benefit-sharing contracts,” said the EU.

Norway calls for an annex with “precision and flexibility”.

Norway, speaking for Australia, Canada, Japan, Switzerland and the UK, said that the annex needs “precision and flexibility”.

“Market failure is the norm, not the exception, for emerging infectious diseases”, with research and markets “driven almost exclusively by public funding”.

“This has serious implications for what we can expect to deliver through the PABS system,” Norway warned.

It called for engagement with experts and the need to test concepts, including through simulation, “to ensure that we can build a feasible and implementable PABs system”. 

Stakeholder reflections

The Pandemic Action Network (PAN), speaking for several other stakeholders, said that the annex “must fully operationalise Article 12 of the Pandemic Agreement, and it must create legal certainty for benefit sharing”. 

The heart of the Pandemic Agreement includes the agreement that, during a “pandemic emergency”, each manufacturer participating in the PABS system will target to make 20% of their real-time production of safe, quality and effective VTDs available to the WHO, with at least 10% of this as a donation.

“More details are needed to advance the 20% real-time production goal, including on non-exclusive licences and technology and knowledge transfer, as well as on timelines, traceability and accountability,” said PAN.

PAN’s Eloise Todd (left).

The South Centre stressed that the PABS system needs to align with international rules and proposed that it include “standard contracts” with manufacturers.

The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said that the annex needs to define measures “to strengthen, facilitate and accelerate research and innovation, as well as the fair and equitable sharing and distribution of benefits and avoid reopening already agreed principles”. 

However, the IFPMA said that the current draft “introduces overly broad definitions that could capture pathogens with no real pandemic potential and mandatory financial contributions that will disincentivise participation”. 

The IFPMA also warned that the draft fails to ensure that national Access and Benefit-Sharing (ABS) laws “will not apply to PABS,  leading to potential stacking of obligations and legal uncertainty”.

ABS regulations are country regulations that set out the terms for obtaining genetic resources and sharing the benefits derived from them, based on the Nagoya Protocol and the Convention on Biological Diversity (CBD).

The IFPMA also said that the draft harms “critical innovation by making broad restrictions on intellectual property”.

“These provisions not only fall short of offering practical solutions to improve equitable access, but they also actively threaten the mechanisms that enable the industry to rapidly develop and scale up delivery of effective products during the last pandemic,” the IFPMA concluded.

Most stakeholders appealed for full access to the talks, as previously agreed. Knowledge Ecology International stated that an open and transparent negotiation process, as is the practice at the World Intellectual Property Organization (WIPO),  would help to diminish misinformation about the Pandemic Agreement.

South Africa’s Minister of Health Aaron Motsoaledi and UNAIDS director Winnie Byanyima at the report launch in Johannesburg.

The poorest people and countries suffer the most during pandemics, setting in motion a “vicious cycle” of inequality where those who suffer the most are least equipped to address disease outbreaks, according to the Global Council on Inequality, AIDS and Pandemics in a report released on Monday (3 November).

The COVID-19 pandemic pushed 165 million people into poverty, with women, informal workers, and ethnic minority groups experiencing the worst income shocks.

The pandemic also raised the debt of developing countries to $3 trillion, and more than half of low-income countries are either in debt distress or at high risk of it. 

In comparison, the world’s richest people increased their wealth by 25%.

“The rich had a very good pandemic. There was an increase in billionaires and an increase in their wealth, while poorer people got poorer,” said Professor Michael Marmot, director of the Institute of Health Equity at University College London.

“The pandemic increased social and economic inequality, which means that we’re less well prepared for the next pandemic unless we act on the conditions in which people are born, grow, live, work and age, and the fundamental drivers of those inequalities,” added Marmot, co-chair of the council, addressing the report launch in Johannesburg.

“If we reduce inequalities – including through decent housing, fair work, quality education and social protection – we reduce pandemic risk at its roots. Actions to tackle inequality are not ‘nice to have’; they are essential to pandemic preparedness and response.”

Professor Michael Marmot, director of the Institute of Health Equity at University College London and council co-chair.

‘Diseases fester and stay’

“Where these inequalities are biggest, where the most unequal are, within their countries and between countries, that is where we see diseases festering and staying,” UNAIDS director Winnie Bwanyima told the launch.

“These inequalities drive pandemics, prolong them, make them more deadly and make them more economically disruptive. And when that happens, we see inequality continuing to increase. That is a cycle.”

More unequal countries had significantly higher COVID-19 mortality, HIV infection, and AIDS mortality, according to the report, which was compiled over two years.

Epidemics of H1N1 influenza, SARS, MERS, Ebola, and Zika have led to “a persistent increase in inequality that peaked about five years later”.

Debt relief

“Pandemics are not only health crises. They are economic crises that can deepen inequality if leaders make the wrong policy choices,” said Prof Joseph Stiglitz, council co-chair and Nobel Laureate in Economics.

“When efforts to stabilise pandemic-hit economies are paid for through high interest on debts and through austerity measures, they starve health, education and social protection systems,” he added.

Prof Joseph Stiglitz, council co-chair and Nobel Laureate in Economics.

“Around 60% of tax revenue in sub-Saharan Africa goes to servicing the debt, and that means less money is left over to provide medicines to address the disease directly, but also to stop the growth of inequality. Societies then become less resilient and more vulnerable to disease outbreaks.”

Stiglitz added that breaking this cycle means “enabling all countries to have the fiscal space to invest in health security.”

One of the report’s key recommendations to address inequality is through debt relief for developing countries to alleviate long-term economic harm and stop the cycle of disease outbreaks deepening inequality.

Debt repayments “crowd out spending on today’s pandemics and preparation for tomorrow’s,” the report notes.

The council is “deeply worrying that AIDS remains a pandemic”, and that, with tuberculosis and malaria, “it continues to cause millions of deaths, disproportionately in low- and middle-income countries and among marginalised groups in high-income countries”. 

Aside from debt relief for countries affected by HIV from now until 2030, the report also proposes that affected countries have access to the  International Monetary Fund’s (IMF) Special Drawing Rights.

It also wants international financial institutions to stop financial assistance that encourages “pro-cyclical austerity policies” and to rather address the “structural flaws that lead to insufficient fiscal space to reverse inequalities and to stop pandemics”.

Stiglitz also called for a “reserve fund” that countries can access “the moment that the World Health Organization says there’s a pandemic”.

By the end of 2024, new HIV infections fell to their lowest level since 1980, but this year’s “rapid donor withdrawal threatens gains and leaves the most vulnerable behind.”

Local medicine production

Monica Geingos, council co-chair.

The third co-chair of the council, Monica Geingos, addressed the lack of local production of vaccines and medicines, which affects access to medicines.

The tragedy is that breakthroughs in medicines and technologies for HIV, COVID-19 and other diseases are not reaching the vulnerable populations quickly enough, and this prolongs inequities in access to optimal care and prevention,” said Geingos, former First Lady of Namibia.

“Six months after COVID-19 the vaccines had received approvals, high-income countries had 90% of what they needed to cover priority populations, while low-income countries received only enough to cover 12% of the priority populations,” said Geingos.

“We’re at an awkward place where breakthroughs in science and technology have still been met by a failure to share technology across borders in pandemics,” she noted.

“The intellectual property barriers and the insufficient manufacturing capacity together mean that the supply of pandemic technologies continues to be insufficient to the needs of those who need them the most. 

“World leaders need to look at increasing global funding for regional production and create a pool mechanism for technology transfer. Brazil has already proposed a global coalition that we support, and the international financial institutions, like the World Bank, should support and enable that coalition to address the pandemics of today, like AIDS and TB, so that we prepare for those of tomorrow.”