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Global Health Centre and SWI swissinfo, Neira outlined her vision for WHO at a time when the United States has withdrawn, other countries are reducing funding and public confidence in health institutions is being challenged by misinformation.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.

The blue cartridge contains three sputum specimens, which are being tested together using a GeneXpert machine. If the result is positive, each sample will then be tested separately. If the cartridge is negative, none have to be individually tested.

At a laboratory in Cameroon, technicians receive sputum samples from people suspected of having tuberculosis (TB). Until recently, each person’s sample required a separate test cartridge to detect the bacteria that causes TB. But when cartridges become scarce, the country’s National TB Program found a way to make existing resources go further: testing samples from several people together, using a single cartridge.

The approach, known as pooled testing, is helping laboratories process more samples with fewer cartridges, reducing costs and allowing more people to access TB diagnostics.

For Ngono, a 14-year-old girl in rural Cameroon, this change made a critical difference. After developing a persistent cough, she waited three months for a TB diagnosis. The nearest laboratory with GeneXpert – the main molecular test for diagnosing TB in children recommended by the World Health Organization (WHO) – was 16 km away. 

But for her, distance wasn’t the greatest barrier: when her sputum (phlegm) sample reached the lab, a backlog of samples and shortages of testing cartridges further delayed her diagnosis. 

When Cameroon introduced pooled testing, the laboratory was finally able to process her sample, confirming her TB diagnosis and allowing her to start treatment. Ngono’s experience illustrates how making better use of existing resources can help overcome barriers that might otherwise prevent people from receiving a timely diagnosis, sometimes with life-threatening consequences. 

Smarter delivery can lower costs

An estimated one in four people with TB globally are still undiagnosed and untreated. WHO recommends that everyone with signs and symptoms of TB receive a rapid molecular test as their initial diagnostic, yet only 54% currently do, largely because these tests remain costly for health systems and therefore out of reach for many.

Pooled testing addresses this gap: by testing multiple samples together, it stretches limited resources further, allowing more people to access testing using the same platforms that can detect TB and drug resistance within hours rather than weeks.

This challenge is becoming more pressing as global health enters a new era of constrained financing. The decline in donor funding underscores the need for increased domestic funding and greater national ownership of health programs. But this shift will not happen overnight. In the meantime, across countries, fewer people are being reached with essential services, and progress against diseases like TB is at risk of being reversed. Millions continue to face stark barriers to access the diagnosis, treatment and care they need. 

As funding tightens, it is essential for governments, funders and global health partners to continue investing in research, development and innovation, because diseases do not slow down when funding does: they continue to evolve, spread, and adapt. 

Meeting the challenge in today’s constrained financial environment will require a broader view of innovation, one that goes beyond developing new technologies to include smarter ways of delivering existing technologies.

How pooled testing works

 

Normally, diagnosing TB requires each person to provide a sputum sample, with one test used per individual. Pooled testing changes that: samples from up to four people are combined and tested together with a single test cartridge. 

If the pooled sample is negative, everyone in the group receives a negative test result. If it tests positive, samples that made up the pool are retested individually to identify who has TB. The potential is significant: fewer tests used, freeing up resources that can be reinvested to reach more people.

In Cameroon, this approach emerged out of necessity, in response to a cartridge shortage that had pushed the country’s TB testing capacity to a breaking point. By pooling samples at selected laboratories, the National TB Program reduced cartridge use by around 65%, lowering the estimated cost of molecular testing from about $8 to $2.80 per person. 

With the same resources, nearly 39,000 people accessed molecular TB testing, compared with just over 21,000 with individual testing – a nearly 85% increase in diagnostic coverage. 

By testing multiple samples together, pooled testing stretches limited resources further, allowing more people to access testing using existing platforms that can detect TB and drug resistance within hours rather than weeks.

In early 2026, the WHO issued new recommendations that endorsed pooled testing as a cost-effective strategy to increase TB screening. 

These recommendations draw on evidence from multi-country studies funded by Unitaid and led by the Liverpool School of Tropical Medicine and the Stop TB Partnership, with eight partners across seven countries (Bangladesh, Brazil, Cameroon, Kenya, Malawi, Nigeria and Viet Nam), and reflect a broader shift toward decentralized testing approaches that address longstanding access barriers. 

In Cameroon, the National TB Program is already demonstrating what this looks like in practice.

By rethinking how existing tools, infrastructure, and resources are used, rather than just introducing new technologies, the country has demonstrated what smarter delivery can achieve. This kind of practical, real-world innovation can increase access, improve efficiency, and transform the impact of global health investments. 

Sputum samples are being prepared to be tested in one GeneXpert cartridge.

Turning efficiencies into a global health priority

 Cameroon’s experience illustrates an important lesson: in today’s health financing environment, how health innovations are delivered is just as critical to health outcomes as developing new technologies. 

Efficient approaches like pooled testing ensure that resource constraints do not translate into reduced testing coverage. Instead, they have the potential to vastly increase the number of people who can be tested with the same resources – a critical step toward finding the “missed millions” and moving closer to ending TB. 

Unlike many new technologies that might require new devices or extensive training, pooled testing is ready to be implemented. It uses existing infrastructure and resources, and requires minimal additional training for laboratory technicians. 

For people seeking care, nothing changes in how they give a sample or get results, except they are more likely to be tested on time. Countries do not have to wait years to benefit. Because pooled testing builds on existing laboratory equipment, implementation can begin quickly, and results can be seen within months – expanding testing coverage, reaching more people, and reducing costs for national TB programs.

But access to these efficient approaches is not automatic. Even when evidence exists and tools are available, they can only be brought to scale through deliberate, coordinated action.

The health financing crisis makes this urgent. Innovating in the way we deliver existing tools is not just about efficiency: it is the most effective way of expanding access while enabling countries to transition toward more sustainable, nationally-owned health responses, even as external funding declines. But realizing this potential requires moving beyond fragmented individual efforts to collective global action.

This means three things: First, making it easier for countries to scale proven approaches now through coordinated technical support, clear and practical implementation guidance, including how-to videos, and alignment among partners to accelerate adoption. 

Second, investing in identifying where delivery innovation can be applied across other disease areas or for multi-disease testing and treatment. This means strengthening operational research, cross-disease learning, and evidence generation. 

And third, aligning countries, donors, and partners to scale what works. Without stronger coordination, even the most effective innovations risk remaining underused.

Developing new tools will remain essential, particularly as we face new and emerging health threats. But Cameroon’s experience with pooled testing demonstrates that optimizing delivery can unlock enormous gains – expanding access, improving equity, strengthening health systems, and contributing to finding the missed millions with TB. 

As global health enters a new era, the question is not whether innovation remains essential, but whether the global health community will prioritize both technological discovery and smarter use of existing tools – and act collectively, and with urgency to bring both to scale. 

Dr Noah Appolonie is the Cameroon National TB Program coordinator.

Dr Philippe Duneton is Unitaid’s outgoing executive director.

Dr Lucica Ditiu is executive director at Stop TB Partnership.

Dr Tom Wingfield is the deputy director of the Centre for Tuberculosis Research at the Liverpool School of Tropical Medicine (LSTM).

 

Image Credits: Stop TB Partnership.

Attendees flood in on the opening day of COP31 in Antalya, Türkiye.

ANTALYA – The 31st United Nations (UN) climate conference, COP31, got underway on Monday in the Turkish coastal city of Antalya, where some 100,000 people, including more than 90 heads of state and hundreds of ministers from nearly 200 countries, will gather over the next two weeks to decide what the world will or will not do to protect the future of the planet.

As has become routine, the summit follows a year of record-setting heat, floods, wildfires and drought across the globe. It is also the first since the UN Environment Programme (UNEP) concluded that the chance of holding warming to 1.5°C, the Paris Agreement’s landmark limit, “has been lost.”

On arrival at the sprawling Antalya Expo Centre, attendees who had not collected their badges the night before met a level of disorganisation reminiscent of the state of the negotiations themselves. This reporter’s wait to enter the venue lasted three hours, 21 minutes and 20 seconds, while others, stuck in highway traffic or unable to board the few buses, shuttles and trams to the venue, fared far worse.

For those brave enough to make it inside, the national pavilion halls play out like a world’s fair. Tajikistan’s is adorned with glaciers, a reminder of the Himalayan glacier collapse accelerated by climate change that killed more than 1,300 people in Nepal in August. Brazil’s is a rainforest, Oman’s a desert.

Across the hall, the UK pavilion honours the man who has arguably done more than anyone to protect the ecosystems the pavilions celebrate, the 100-year-old Sir David Attenborough.

UK Pavilion at COP31.

From the moment planes land to when buses and trams pull into the Expo Centre grounds, COP31-themed slogans blanket the city. Some play on time (“Protecting tomorrow is today’s work”), others on public transit (“Next stop: a better future,” painted on the COP31 tram). Some are classic UN jargon (“Dialogue. Consensus. Action.”), while others are just silly (“Let’s COP!”).

Yet one in particular best captures what the hosts, delegates, civil society and attendees in Antalya hope the summit will deliver: “Where dialogue becomes action.”

“COP31 must help close the gap between commitment and delivery,” said Australian climate minister Chris Bowen, who presides over the negotiations under a power-sharing deal with Türkiye. He has made finance, electrification and the ocean his priorities, and advocates: “We must turn climate ambition into real-world outcomes.”

So can the world deliver?

“The success of the next two weeks of talks will be judged by two things. The appetite to deliver on the promises we have made, and the ability to move beyond the culture of declarations that has sullied previous conferences,” said Mohamed Adow, director of the Nairobi-based think tank Power Shift Africa.

Let’s COP!

A large animated dome sitting atop the food court flips through animations of the globe, COP31 logos and the Turkish flag.

In hallowed COP tradition, the opening ceremony began an hour and a half late. The talks ran into Sunday night, stumbling over developing countries’ demands to put climate finance on the official agenda. Still, by previous years’ standards, this was a relatively short stalemate.

While the overtime talks secured an agenda item on climate finance, a two-year work programme agreed in Belém on how rich countries meet their obligation under the Paris Agreement to fund climate action in developing ones, it came at a compromise.

An African Group request for a separate item on tripling adaptation finance, the money that helps countries cope with heat, floods and failed harvests, was withdrawn after late-night talks and will be taken up under other items instead, according to Climate Home News and AFP.

Adaptation finance was a key target of civil society and developing nations alike in the run-up to COP31 because of the confusion in the text agreed last year. At COP30 in Belém, countries pledged to “at least triple” adaptation finance by 2035, but never agreed on a baseline year to triple from, or a dollar figure.

As it stands, depending on how it is measured, the pledge would cover just 20% to 29% of the roughly $420 billion a year, adjusted for inflation, that developing countries will need by 2035 to adapt to a fast-accelerating climate crisis, UNEP found in its annual Adaptation Gap Report last week.

An interactive map charting the flight paths and emissions of COP attendees.

As money continues to fall short and warming accelerates, the 44 least developed countries (LDCs) called the looming overshoot of 1.5°C “a grave betrayal of our countries who have contributed least to this crisis” in their opening-day statement.

“COP31 cannot be another exercise in deferring difficult decisions,” said the group’s chair, Ambassador Adão Soares Barbosa of Timor-Leste. “It must deliver urgent emissions reductions, address temperature overshoot, access finance and tangible protection for those most at risk.”

‘Pandemic proportions’

Top health and climate officials gather at a high-level ministerial meeting on COP31’s Health Day.

Türkiye opened COP31 with a Health Day, and health ministers and global health leaders from Geneva to the Pacific came to Antalya to argue that the health consequences of climate change have reached catastrophic proportions.

“No health system can be made resilient to an endlessly warming world,” Simon Stiell, the UN’s climate chief, told health ministers. “We must drive the transition away from fossil fuels fast and fairly.”

Stiell added that a health system can falter by degree: “A ward grows hotter. The power flickers. A refrigerator holding medicines fails. Floodwater enters a well. A mother in labor finds the road to the clinic cut off.”

At a separate press briefing on Monday, Stiell said the climate crisis is now “a global health crisis of pandemic proportions.”

Heat was linked to a record 710,000 deaths in 2023, almost three-quarters of them caused by climate change, the Lancet Countdown found last month. Air pollution from burning fossil fuels killed another 2.78 million people that year, and The Lancet authors argued that WHO should create a new category of public health emergency to classify the climate crisis.

“We can say that most heat deaths around the world are caused by climate change,” said Diarmid Campbell-Lendrum, who leads WHO’s climate and health work. “They’re climate change deaths.”

Money for war and death

Opening plenary of COP31 in session.

But as dire warnings of health threats echoed around the room, for a third consecutive COP, following Brazil and Baku, governments did not announce any new investment or financing.

“Let me be direct,” said Brazil’s Health Minister, Alexandre Padilha. “Financing for health adaptation is insufficient and is falling down.”

International public commitments for health adaptation fell from about $3.2 billion in 2022 to $2.2 billion in 2024, just 5% of all international public adaptation finance, Padilha said.

Development aid fell 23% in 2025, its largest drop on record, according to OECD figures he cited, while global military spending has risen 41% in a decade to $2.9 trillion.

“Why [is there] always so much money for war and death,” he asked, “and so little for health, environment, and life?”

‘Declarations do not protect people’

Bridge to COP31 stretches over a highway, with Antalya’s surrounding mountains in the backdrop.

Dr Tedros Adhanom Ghebreyesus, at his last COP as WHO Director-General before his term ends next August, traced health’s climb up the climate agenda, from pledges on climate-resilient health systems in Glasgow in 2021 to the first COP Health Day in Dubai and the Belém Health Action Plan last year.

“Each of those steps was driven by health ministers, but declarations do not protect people,” he said. “Implementation does.”

Tuvalu Health Minister Tuafafa Latasi said he spoke “from the front line of an immediate clinical and public health emergency,” with three of his country’s nine islands at high risk from cyclones, rising seas and salt seeping into groundwater.

“Protecting health in Tuvalu is a test of our shared humanity,” he said. “Our call at COP31 is simple: match strong climate commitment with practical support.”

In a WHO survey last year, more than 90% of countries named insufficient finance as a top barrier to their health and climate plans, Tedros said. Yet health has no item of its own in the formal talks, where climate finance is negotiated.

Resilient health systems are one of 10 priorities on Türkiye’s voluntary action agenda but, unlike electrification or waste, they have no numerical targets for 2035.

“Health is the human face of climate change,” Tedros told ministers. “It belongs in the negotiated text. It should be an explicit eligibility area for climate finance and its share should grow as adaptation finance grows.”

New ‘initiative’ launched

The headline launch from Health Day came with Türkiye and WHO’s announcement of what is known as the Antalya Initiative for Resilient Health Systems (AIR).

It is a voluntary scheme through which countries document what has worked in protecting health from climate shocks, what has not and what it cost, and share those lessons. In short, a shared feedback platform. But no countries announced their participation in the initiative as of Monday night.

“We want a successful solution developed in one country to be able to save lives in another,” said Türkiye’s Health Minister Kemal Memişoğlu. “We want to ensure that no country has to waste time reinventing solutions for the same problems.”

The initiative is designed to complement WHO’s Alliance for Transformative Action on Climate and Health (ATACH), a network of more than 100 countries that will hold their own summit on Tuesday at the COP31 health pavilion.

No funding, staff or list of participating countries has been published. Eighteen health organisations, led by Health Care Without Harm, have asked for the initiative to include a dedicated pillar for health workers.

Belém funding framework

WHO Director-General Dr Tedros Adhanom Ghebreyesus speaks at COP30 in Belém. The summit saw the launch of the Belém Health Action Plan, a Brazilian-led initiative that aligns with the WHO’s broader Global Action Plan on Climate Change and Health.
At COP30 in Belém, Director-General Tedros Adhanom Ghebreyesus called the formalising of Belém Health Action Plan a historic shift in the role health plays in climate talks. One year later, it has 40 signatories.

Brazil, meanwhile, launched a financing framework for the Belém Health Action Plan, a voluntary list of about 60 non-binding measures now endorsed by 40 countries since it was launched last year.

Drawn up with Wellcome and the Rockefeller Foundation, it sets out for each measure which kinds of money could pay for it, from climate funds and development banks to philanthropy and national budgets, along with likely partners and examples of where it has worked.

“I wish to make it very clear: this is not a new fund,” Padilha said. “It’s a map to help countries make better use of the mechanisms that already exist.”

Much of what the plan covers, such as disease surveillance, early warning systems and training health workers, generates little or no revenue, Padilha said, yet countries are being asked to take on debt to pay for it. The framework is meant to steer those measures toward grants and public money instead, with progress to be reported by COP33 in 2028.

“With the financing framework, we have the map,” he said. “Now we need the investment.”

Alan Dangour, Wellcome’s director of climate and health, announced that the Climate and Health Funders Coalition, which pledged $300 million in Belém, had awarded more than $225 million in its first year and attracted $150 million in new commitments.

“We should approach climate negotiations as though people’s lives depend on them,” Dangour said, “because they do.”

‘Off the charts’

Earth’s energy imbalance (EEI) from 1960 to 2025 as estimated from ocean heat
content.

The past 12 years are the 12 warmest on record, and the past four are the warmest of all, the WMO said in its report. Global temperatures from January to September averaged about 1.47°C above pre-industrial levels, and are likely to climb further as El Niño, forecast to be the strongest on record by December, takes hold.

“El Niño and indeed the state of the global climate in 2026 gives new meaning to the phrase off the charts,” said WMO Secretary-General Celeste Saulo. “El Niño doesn’t add new heat to the planet. It releases heat from the ocean, which is the warmest ever measured.”

Saulo told reporters to “prepare for another record-breaking year in 2027.” Europe’s heatwaves, drought and wildfires this year caused more than 30,000 excess deaths by preliminary estimates, the report found.

For the first time, WHO has classified El Niño’s expected health impacts as a health emergency, according to WMO. The Lancet Countdown has urged WHO to go further and create a new instrument recognising climate change itself as a global health emergency.

Three in four national weather services send health information to their countries’ health ministries, Saulo said, but only one in four ministries treats it as relevant to their decisions.

“Early warnings help save lives. Early warnings for heat, for floods, for droughts,” she said. “But they cannot be just headlines. They need to be translated into action.”

Image Credits: WHO/PAHO/Karina Zambrana .