Data centre electricity consumption will double by 2030. But solutions exist, experts at an AI for Good panel in Geneva: (L-R) Molly Webb (Energy Unlocked), Laura Schade (UK), Cyrille Brisson (Eaton), Thomas Spencer (IEA), Priyanka Dasgupta (moderator).
Data centre electricity consumption will double by 2030. But solutions exist, experts at an AI for Good panel in Geneva: (L-R) Molly Webb (Energy Unlocked), Laura Schade (UK), Cyrille Brisson (Eaton), Thomas Spencer (IEA), Priyanka Dasgupta (moderator).

The explosive growth of artificial intelligence is siphoning off water and electricity supplies used by communities around the globe, and creating new sources of air pollution and climate emissions from additional power generation. Yet, experts and industry representatives claim that the technology holds the key to mitigating the very crises it compounds. Advanced algorithms are already driving profound environmental solutions, ranging from monitoring municipal water leakages to forecasting renewable energy generation. Efficiency and standardisation issues remain the biggest barriers.

Despite accounting for a relatively small fraction of total global electricity usage today, the growth trajectory of AI is alarming. Projections by the International Energy Agency (IEA) indicate that data centre electricity consumption will double to 950 terawatt-hours by 2030, driven largely by specialised AI workloads and computing facilities.

Last year, data centres consumed about 485 terawatt-hours of electricity globally, representing 1.5 percent of worldwide use.

“We estimate that their electricity consumption increased by 17 percent last year, growing more than five times faster than total electricity consumption,” said IEA-expert Thomas Spencer. He was part of a panel session on data centres’ climate impacts at this week’s AI for Good Summit in Geneva.

From 7 to 10 July, more than 12,000 visitors, experts, regulators and diplomats crowded the hallways of Geneva’s Palexpo exhibition grounds to discuss the potential and limits of AI. The summit was organised by the International Telecommunications Union (ITU), alongside 50 UN partner agencies, other UN member states and the private sector.

 

Data centres in the United States, planned, under construction and operational; hyperscale centres concentrated in states like Virginia, Texas and California have raised the most concerns.

This exponential demand in AI energy demand places immense pressure on existing power grids and frequently forces utilities to rely even more on fossil fuels, including dirty diesel backup generators. According to the IEA, some companies in the United States have already begun expanding natural gas-fired capacity to meet the surging demands generated by localised AI data centres.

More immediately, the increasing reliance of data centres on backup diesel generation, which emits toxic particulate air pollution, has stimulated a big backlash from communities and environmental groups in the US, which hosts 37% of the world’s total data centre installations.

The surge in fossil-fuel combustion, in general, threatens climate targets and exacerbates localised air pollution, directly impacting respiratory and cardiovascular health in surrounding communities.

Spatial concentration drives local conflicts

AI data centers consumed about 485 terawatt-hours of electricity globally.
Data centres consumed about 485 terawatt-hours of electricity globally, largely driven by AI expansion.

In local communities, mounting frustration stems primarily from the unique physical footprint of modern digital infrastructure. Unlike traditional industrial facilities, hyperscale AI data centres cluster tightly together and locate themselves near urban populations, experts point out.

“I would summarise the answer to this question as the three S’s: size, speed, and spatial concentration,” said Spencer.

Skybox Power Campus under construction near Austin, Texas, with onsite power infrastructure.

These facilities expand from initial announcements to fully commissioned gigawatt-scale campuses in just two to three years. This rapid development severely outpaces the decades-long planning cycles required to upgrade municipal electrical transmission grids.

The frustration is compounded by frequent opaque governmental decision-making. “There has been a real lack of transparency and a lot of secrecy around some of these data centres,” explained climate expert Molly Webb, CEO of the NGO Energy Unlocked.

Evaporative cooling strains water supplies of local communities

Due to its high-energy demand, AI expansion is compounding energy and water crises.
Due to its high-energy demand, AI expansion is compounding energy and water crises.

Consequently, data centres overwhelm local utility networks and compete directly with residents for essential resources like water as well as energy supplies.

A single 100-megawatt hyperscale facility can consume 2.5 billion litres of water annually, drawing directly from municipal drinking supplies, according to a 2025 report by the UK Government Digital Sustainability Alliance (GDSA). This volume is equivalent to the daily water needs of approximately 80,000 people.

Communities view some of these AI data centres as a direct threat to public health. When municipal water systems collapse under the strain, the immediate casualties are local sanitation and hospital operations.

UN urges recognition of water bankruptcy

The Mesa Data Centre near Phoenix, Ariz. Two-thirds of U.S. data centres built or in development since 2022 are in water-stressed areas.

Meanwhile, the world has entered the era of global water bankruptcy, a crisis threatening Sustainable Development Goal 3 for good health and well-being, and Goal 6 for clean water and sanitation. The UN has urged states to formally recognise that human-water systems have exceeded their hydrological limits and sustained irreversible damage.

Attempting to manage this reality with crisis tools alone produces escalating emergency costs, deepening ecological damage, and rising social conflict and inequality, the 2026 UN Global Water Bankruptcy report states.

According to the UK GDSA report, policymakers should adopt a water protocol that requires data centre operators to face stringent new barriers to entry. Facilities could be forced to secure non-potable water sources or invest heavily in dry-cooling architecture before receiving construction permits.

See related story.

World Enters New Era of Water Crisis, UN Says

Innovation for sustainable cooling systems

Reacting to the public pushback, the technology industry is developing less resource-intensive systems. Many hyperscale developers have begun implementing closed-loop cooling systems in new facility designs.

These closed water systems drastically cut consumption, offering a vital improvement over traditional evaporative cooling.

However, these systems require facilities to consume more electricity to cool the hardware, creating a difficult environmental trade-off, according to Cyrille Brisson, global data centre expert at the private company Eaton.

“When you want to eliminate water usage you have to consume more power… if you want to go zero water you worsen your power usage effectiveness,” said Brisson.

Data centres require vast amounts of energy to sustain system cooling.
Data centres require vast amounts of energy to sustain system cooling. The industry is looking for new solutions to increase efficiency.

Making AI more energy efficient

Simultaneously, hardware manufacturers are pushing the thermal limits of their processors to eliminate water consumption through evaporation.

Breakthrough architectures now utilise liquid coolants operating at 45 degrees Celsius, allowing facilities to manage heat without activating mechanical chillers. These high-temperature systems also can enable developers to recover waste heat for neighbouring residential buildings, transforming a major energy liability into a community asset.

Despite these advancements, industry experts note that such innovations remain geographically dependent, as facilities in warmer regions still require chillers during peak summer heat.

Reducing AI complexity to save power

AI data centres perform billions of mathematical operations, often leading to inefficiencies.
AI data centres perform billions of mathematical operations per prompt, often leading to inefficiencies – as well as outsized consumption of energy and water.

To meet these sustainability challenges, independent developers are also simplifying the trillions of mathematical calculations per AI prompt. During the summit’s Resilient AI Challenge, global teams proved that sophisticated optimisation can drastically shrink the hardware and energy requirements of generative models.

When developers combine mathematical simplification (quantization) with smaller, task-specific models and optimised user prompts and responses, the computational burden drops drastically. Together, these approaches can reduce the energy required for AI systems by up to 90% for specialised and routine tasks, according to a UNESCO report, referenced by UNESCO assistant director-general Gabriela Ramos.

Independent developers are practically demonstrating these efficiency techniques in real-world scenarios. For example, a joint research team from the Chinese Academy of Sciences and Beijing Forestry University successfully dropped a model’s inference energy consumption by nearly 70%.

This shift not only slashes electricity demand but also democratises access, allowing hospitals and municipalities in lower- and middle-income countries to run AI locally on affordable hardware.

Can AI also help mitigate climate and pollution crises?

Solar-powered data centres have potential but also face significant challenges including land requirements, intermittent energy production, and grid integration issue.

Eventually, AI technology should serve as a potent tool for climate mitigation, experts also contend. The IEA projects that AI applications could reduce global emissions by up to 1.4 gigatons by 2035 through more systemic energy optimisation. AI can drive profound water waste solutions, ranging from monitoring municipal water leakages and optimising crop irrigation, to cleaning water supplies and improving extreme weather forecasting.

“We should stop seeing data centres just in terms of energy demand, but we should look at them in terms of systems that can enable decarbonisation,” said Laura Schade, a senior engineer at the UK Department for Energy Security and Net Zero, speaking at the AI for Good panel.

Advanced algorithms process vast amounts of satellite and sensor data to forecast renewable energy generation with unprecedented accuracy. This predictive capability allows grid operators to integrate wind and solar power seamlessly, reducing reliance on fossil fuels.

Data centres themselves are also evolving into active grid participants rather than passive energy drains. By adjusting their computational workloads during peak hours, facilities can stabilise volatile renewable grids through instant flexibility.

Battery energy storage systems can replace diesel generators during outages, avoiding high pollution. And finally, pairing renewable microgrids with data centre development can integrate clean power from the get-go, notes the World Resources Institute, in a recent policy brief.

Supporting that, government regulatory processes should require companies to disclose on-site power strategies and evaluate cleaner alternatives during planning, review and permitting. At the same time, the nature of solar’s intermittent energy production also poses challenges for developing data centres entirely around solar-power.

The standardisation bottleneck

 

AI data centres are concentrated in China, South-East Asia, North America and Europe. In the coming years, a massive scale-up is expected across the globe.
Experts point to the need for standardisation, with a massive global scale-up of AI data centres expected across the globe.

However, industry representatives warn that uncoordinated national regulations could also slow more sustainable deployment of data centres.

“What I dread is having a different standard by country because that’s what’s slowing down deployment of innovation tremendously,” said Eaton’s Brisson.

To prevent bottlenecks, the Swiss-based nonprofit International Electrotechnical Commission (IEC) is accelerating the update of 50 data centre safety and electrical standards into a two-year timeframe. A process that historically took decades, but that is now accelerated due to the explosive expansion of AI.

Beyond hardware, the implementation of sustainable AI in developing nations frequently stalls due to poor data quality. This threatens to increase the digital divide between the global north and the global south.

“The binding constraint was never the algorithm, it was the data standardisation,” said Gyungah Kim, manager at the Korea International Cooperation Agency at the summit.

Sustainability: A defining measure of excellence

The debates in Geneva reflect a maturation of the AI industry, moving past speculative hype toward concrete implementation. Companies and governments must now develop and implement robust regulatory guardrails and demand-side measures to react to public distrust and frustration.

Otherwise, the AI revolution risks further accelerating the very climate and resource crises it currently promises to solve, a sentiment echoed by UNESCO assistant director-general Ramos.

“Sustainability must become a defining measure of AI excellence,” she said.

Image Credits: European Union, Felix Sassmannshausen/HPW, WRI , International Energy Agency, Steve Heap/Shutterstock, Luis Tosta via Unsplash, Around the World Photos/Shutterstock , Matheus Bertelli via Pexels, Data Center Knowledge / Alamy.

Women wait to be screened for breast and cervical cancer at the RAiSE Foundation center in Niger State.  Across the continent, however, access to cancer screening and diagnosis remains patchy and inconsistent.

Africa can no longer afford to manage cancer care as a perpetual crisis. Instead, policy leaders must recognize this crisis for what it truly is: the ultimate ‘stress test’ for national health systems.  The WHO Global Status Report on Cancer, published this week, highlights the persistent inequities in access to timely cancer diagnosis and treatment and disproportionately high levels of cancer mortality across the continent. When a system is overwhelmed, it reveals deep-seated fractures in how we finance health as a whole. But this is not just a fiscal failure; it is a human one.

Across Africa, late cancer diagnosis continues to place a devastating financial burden on families, many of whom delay seeking care because treatment remains unaffordable and out of reach. By then, care becomes more complex, survival is less likely, and the economic consequences extend far beyond the patient herself. Families are forced to make terrible choices between putting food on the table or seeking lifesaving health interventions. Children leave school. Health systems absorb escalating costs that could have been prevented through earlier intervention.

This individual suffering is the precursor to a looming regional emergency: by 2030, non-communicable diseases (NCDs), including cancer, are expected to become the leading cause of death in many African countries.

If our current fragmented and underfunded models cannot withstand the pressure today, they will certainly collapse under the weight of tomorrow’s demands. The debate now is not whether Africa can afford to invest in cancer care. It is whether the continent can afford not to.

The Hidden Cost of Inaction

Cervical cancer screening lags far behind in Africa, Asia and parts of the Middle East.

The economic cost of inaction is already severe. Research by the WifOR Institute estimates that between 2017 and 2023, HER2-positive breast cancer alone resulted in more than US$10 billion in lost productivity across seven African countries. Nearly 90% of these losses affected women in their prime working years. When women are excluded from the workforce, households become more vulnerable, businesses lose productivity, and economies slow down.

At the same time, treating advanced cancer can cost up to ten times more than investing in early screening and prevention. Continuing to finance cancer care primarily at the point of crisis is therefore not only inequitable but also economically unsustainable.

This urgency shaped discussions at the recent World Health Summit Regional Meeting in Nairobi, where policymakers, clinicians, patient advocates, and health financing experts converged around a common conclusion: Africa must move from crisis spending to long-term, strategic investment in cancer care.

Innovation in Action: African-Led Solutions

A health worker in Dwazark Community, Freetown, Sierra Leone, prepares to give students at St Augustine School the HPV vaccine to protect against cervical cancer. Post-COVID African rates of HPV vaccination have increased.

Africa is already demonstrating real-world solutions.

Côte d’Ivoire has demonstrated one of the boldest financing innovations on the continent by converting national debt into a €400 million “health dividend.” By restructuring expensive commercial debt into long-term concessional financing backed by a World Bank guarantee, the government unlocked savings that were ring-fenced for health and education investments. The approach has already helped expand oncology capacity and improve outcomes, including reductions in breast cancer mortality.

The significance of this model goes beyond debt restructuring. It reframes health financing as a sovereign economic strategy rather than a social expenditure.

Kenya is taking a different but equally important path. Through the Social Health Authority reforms, cancer care is increasingly being integrated into national financing systems as an essential service rather than an afterthought. Strategic purchasing mechanisms are beginning to align financing with population health needs while protecting households from catastrophic out-of-pocket spending.

In Ghana, policymakers recognized that high-cost chronic diseases cannot sustainably depend on general insurance pools alone. Dedicated financing mechanisms for cancer and other NCDs are now helping strengthen sustainable financing while maintaining strong investments in prevention and early screening.

Nigeria, meanwhile, is demonstrating how blended finance and patient capital can expand treatment access. Investments through the Sovereign Investment Authority are supporting world-class treatment infrastructure while lowering long-term costs through technology and scale.

These models differ in structure, but they share the same objective of making cancer care more accessible, affordable, and sustainable.

Beyond the Hospital Walls: Integrating Care

lung cancer
X-ray image of a chest with a potentially cancerous growth.  Critical cancer diagnostics are lacking  in many primary and secondary health care facilities.

However, financing reform alone is not enough.

Cancer care cannot succeed if it remains disconnected from broader primary healthcare systems. Countries that integrate screening, referral systems, diagnostics, and long-term follow-up into primary healthcare are not only improving outcomes but are also building more efficient systems overall.

This is particularly important in Africa, where many women first interact with the health system through maternal and reproductive healthcare services. Integrating cancer screening into these existing platforms creates opportunities for earlier detection while reducing duplication and costs.

But even the best financing models will fail if access remains unequal. As participants repeatedly emphasized during discussions in Nairobi, innovation without access is exclusion. Too many patients still travel long distances for care. Too many are diagnosed late because services are centralized in urban areas. Too many families continue to shoulder hidden costs beyond treatment itself, such as transport, accommodation, lost wages, and caregiving responsibilities.

This is why cancer financing must ultimately be judged not by the size of budgets announced, but by whether it changes the patient’s experience. Does it reduce the financial burden on families? Does it improve survival? Does it bring care closer to communities? If the answer is no, then the system is still failing the people it is meant to serve.

The Prevention Dividend

Healthy diets, including micronutrient rich seeds, legumes and vegetables as well as protein, are an important cancer prevention strategy – but out of reach for one-third of the world’s population or more.

Africa does not lack solutions. It lacks financing systems designed to scale and sustain them.

The shift toward prevention-first systems is not simply good public health policy. It is smart economics. Expanding HPV vaccination, integrating cervical cancer screening into primary healthcare, and strengthening community-based early detection can dramatically reduce long-term treatment costs while saving lives. Prevention remains one of the most underfinanced yet highest-return investments in Africa’s health systems.

Prevention must also extend beyond healthcare services alone. Policies that address the commercial determinants of health, including unhealthy diets, tobacco, alcohol, and harmful trans-fats, are equally critical to reducing the long-term burden of non-communicable diseases and protecting future generations.

To protect these future generations, the time for fragmented programs has passed. Governments, financiers, development partners, civil society and the private sector must now move with far greater urgency to expand domestic financing, scale blended investment models, and build cancer financing systems grounded in African realities rather than disconnected programs. Every delayed reform means more preventable deaths, more families pushed into poverty, and greater economic losses for countries already under pressure. Ultimately, Africa’s future will depend not only on how we treat cancer, but on how urgently we choose to prevent and finance it differently. Shifting from crisis spending to strategic investment is the only path toward a resilient and prosperous continent.

Dr Rispah Walumbe, is the Head of Strategy, Institutional Performance and Policy at Amref Health Africa.

Dr. Paul Chilwesa is the Head- Policy, Population Health & Health Systems Strengthening,  at Roche Africa

 

Image Credits: Etinosa Yvonne/WHO, N. Broutet/WHO, Gavi, National Cancer Institute/Unsplash, FAO/State of Food Security and Nutrition (2025) .

Confirmed cases in DRC rose 25% in a week to 1,759, with 600 dead, as a new UNDP assessment projects the epidemic could push nearly a million people into poverty.

The Democratic Republic of the Congo’s Ebola outbreak is the fastest-growing on record, Africa CDC told its weekly briefing on Wednesday, with confirmed cases up 25% over the past week to 1,759 and deaths reaching 600.

The outbreak’s reproductive number is 1.4, meaning every 10 infections lead to roughly 14 more, while the case fatality rate is 34%, officials said. At Africa CDC’s previous press conference a week earlier, on 30 June, the toll stood at 1,406 cases and 438 deaths.

“The virus is still ahead of our response,” said Wessam Mankoula, who heads the continental Incident Management Support Team coordinating the response for Africa CDC and the World Health Organization (WHO). “However, the window of opportunity is still open.”

The WHO declared the outbreak, caused by the Bundibugyo strain, a public health emergency of international concern on 17 May. No licensed vaccine or treatment exists for the strain, while a therapeutics trial began at an undisclosed site in Ituri, Africa CDC said last week.

“We need to go ahead of the virus,” Mankoula said. “And to go ahead of the virus, we need more resources.”

An economic emergency beyond health

A UN Development Programme assessment released this week warned the outbreak could push 985,000 more people into poverty and cost African economies up to $3.6 billion if regional and global shocks intensify.

Even if the virus is contained in the DRC and Uganda, UNDP projects DRC losses above $1 billion in GDP and 55,000 jobs. The poorest fifth of households face a 1.76% drop in daily consumption, “a loss that erases fragile development gains and threatens to create a long-term poverty crisis,” UNDP said.

“The results tell a clear story about the Africa-wide development cost of the outbreak. Even without widespread transmission, the economic consequences of the Ebola outbreak extend well beyond the epicentre, affecting output, employment, investment, and household welfare across the continent,” the analysis found. “When compounded by global shocks, these pressures intensify and spread further… In all scenarios, the burden falls disproportionately on the most vulnerable households

Women, who dominate informal cross-border trade and the frontline care workforce responding to the outbreak, carry the heaviest burden and “heightened risk” of direct exposure to the Ebola virus, the report said.

“Ebola does not stop at the hospital gate. It affects livelihoods, education, food security, trade, public finances and trust,” said Ahunna Eziakonwa, UNDP’s regional director for Africa. “If we treat this Ebola outbreak solely as a health challenge, we risk missing the much larger development emergency unfolding around it.”

Diverted health services could also cause up to 2,520 excess infant deaths from non-Ebola causes, the report found.

The outbreak “signals a complex development emergency in the sub-region, one that cannot be addressed by exclusively focusing on the health sector,” the report said.

Spread and surveillance

The outbreak spans three provinces and 37 health zones in the DRC, with 94% of cases in Ituri. Six zones have reported no confirmed cases in 21 days. Women account for 53% of infections, most among people aged 15 to 44.

Treatment capacity has nearly doubled to about 800 beds from 460 two weeks ago, but occupancy holds near 95%, and tops 137% in North Kivu.

“Urgently, we need to increase bed capacity by at least 50% immediately to isolate those cases,” Mankoula said. “Any delay in the isolation of suspected and confirmed cases contributes to the spread of the disease.”

The highest fatality rates are in North Kivu, where insecurity blocks responders: 51% in Katwa and 43% in Beni. “Because of security challenges, we are not able to surge our response capacity in North Kivu,” Mankoula said.

Just 32% of new cases come from known contact lists, against a 90% target, and each case is linked to only seven contacts. More than half of cases are flagged only after 72 hours of symptoms. “While progress has been made, key bottlenecks persist, including access to workforce, which currently challenges contact tracing and case investigation efforts,” Africa CDC said, adding that it is deploying 4,000 community health workers as part of a 20,000-strong target with WHO and UNICEF to shore up contact tracing.

Uganda, by contrast, has all but contained its outbreak: 17 of 20 cases have recovered, one remains in hospital, and contact tracing is complete, officials said. “Uganda is still demonstrating that Ebola can be controlled,” Mankoula said.

Workers strike as dangers mount

Wessam Mankoula, who heads the continental Incident Management Support Team coordinating the response for Africa CDC and the World Health Organization (WHO).

Frontline Ebola responders in Ituri walked off the job this week over unpaid wages. Surveillance teams, security staff, community mobilisers and burial teams are among those striking, demanding pay owed since the outbreak was declared on 15 May, according to the Associated Press.

Mankoula said Africa CDC was in touch with the government to fast-track payments, while urging development partners who had pledged to financially assist the response to speed up disbursement. Around 21% of a pledged $1 billion has been disbursed, Mankoula said. The Ebola response needs $518 million, and the wider humanitarian bill exceeds $800 million.

“We are urging all partners and donors to fast-track the disbursement of those resources quickly,” he said. “We need a decent work environment for our frontline healthcare workers who are fighting this growing Ebola outbreak.”

The agency has released $2 million to the DRC, some of which can cover the delayed payments, he added.

Attack on Ebola Hospital in Eastern Congo Echoes Past Violence Against Health Workers

As checks fail to clear, the dangers to medical responders are also growing increasingly deadly. In the current outbreak, 112 health workers have been infected, and 35 have died from exposure to the virus, as health staff risk their lives without pay, frustrating the workforce.

Ebola responses in eastern DRC carry a violent history. At least 25 health workers were killed, and more than 450 acts of violence or threats against them were recorded during the 2018-2020 Kivu epidemic, when 171 health workers also contracted the virus. Shades of that violence have resurfaced in recent weeks, as civilians set fire to Ebola treatment camps across Kivu province.

Mankoula said misinformation continues to drive attacks on responders, as communities continue to doubt the very existence of Ebola and resist safe-burial practices, which require the difficult step of separating a family from their loved one when they pass away, due to the virus remaining contagious after people pass away. The extent of the mistrust is deep, with one Lancet study

A Lancet Infectious Diseases study conducted in Beni and Butembo following the 2018 outbreak found that one in four respondents believed the Ebola outbreak was not real, and that such beliefs were strongly associated with a “decreased likelihood of adopting preventive behaviours, including acceptance of Ebola vaccines.”

“We need more community health workers deployed urgently, and we need to keep protecting our healthcare workers by spreading accurate information, not contributing to misinformation and disinformation, and by making personal protective equipment available to avoid infection,” Mankoula said.

Health workers at Juba Teaching Hospital are waiting in line to have their first shot of COVID-19 vaccine in October 2021, months after millions of people in high income countries had already received the jabs.

As the WHO Intergovernmental Working Group reconvenes in Geneva in the quest to nail down an accord on Pathogen Access and Benefit-Sharing (PABS), the former President of Botswana and the President of AIDS Healthcare Foundation argue that this critical annex to the 2025 Pandemic Agreement needs to ensure benefit-sharing commitments are just as mandatory and enforceable as commitments around rapid and transparent pathogen sharing. 

During the COVID-19 pandemic, inequities were manifested not only through the hoarding of lifesaving technology by rich countries, but also through the unlawful isolation of countries that did the right thing. 

In late 2021, scientists in Botswana first identified and reported a concerning new coronavirus variant, Omicron, which was subsequently identified in South Africa. The two countries had detected, sequenced, and shared the genomic sequence and pathogen samples, only to have their borders closed to the world within days through unfair travel bans that immediately deepened the damage to their economies.

A molecular model of the Omicron subvariant BA.2, which evolved in 2022 from the original Omicron variant first identified in Botswana in 2021.

In December 2021, as the Omicron wave spread, governments convened the Second Special Session of the World Health Assembly (WHA), only the second such session in WHO’s history. They analyzed not only the state of the pandemic but how the 2005 International Health Regulations (IHR), which set a binding legal framework for preventing and responding to the international spread of disease across their 196 States Parties, were not working. The central outcome was a decision to open negotiations on a new global agreement to prevent, prepare for, and respond to pandemics—the Pandemic Agreement.

After more than three years of negotiations at WHO in Geneva, the Pandemic Agreement was adopted in May 2025. One critical piece was left unfinished: the annex operationalizing Article 12 on Pathogen Access and Benefit-Sharing (PABS). This article is meant to correct a critical failure that COVID-19 laid bare: pathogens and sequence data flowed quickly out of the countries that detected them, but the vaccines and treatments developed from the use of this information did not flow back on an equal footing, deepening a crisis that cost millions of lives and trillions of dollars.

The PABS System is one mechanism through which the Agreement gives concrete meaning to equity. It ties each country’s duty to detect and share pathogen samples and genomic sequence information to a corresponding duty on participating manufacturers who profit from that access to provide a share of the vaccines, therapeutics, and diagnostics (VTDs) they produce, along with licensing and financial contributions.

Mandatory to share, optional to give back

Duty to share data on pathogens is being written into the PABS agreement as mandatory.  Seen here, a computer visualization of a DNA sequence. Viruses, like hantavirus and bundibugyo, however, are comprised of RNA sequences, which use uracil, instead of thymine as one of the four base chemicals.

While initially guided by noble objectives to ensure universal and equitable access to build a more resilient and equitable global health architecture, leading developed countries have since taken positions that oppose the basic provisions needed to operationalize the Agreement’s core commitments. What is being resisted is not a technical detail. It is not about charity either.

While the duty to share pathogens is being written into the Agreement as mandatory and enforceable upon states, rich countries are pushing for the corresponding benefit-sharing obligations to be kept deliberately “soft” and unenforceable. The result is a structural asymmetry where samples must flow to private companies, but VTDs are not guaranteed to flow back. The text of Article 12 guarantees minimum shares to be donated and sold at cost to WHO in the event of a pandemic emergency, but no such obligations have been agreed upon when it comes to interpandemic periods or Public Health Emergencies of International Concern (PHEICs), where access to medical countermeasures is most critical to prevent the spread of deadly pathogens.

No one negotiates fairly in an emergency

COVAX
Some of the initial  COVID vaccine deliveries arriving in Africa in May, 2021 – too little too late.

Benefit-sharing obligations for participating manufacturers and other commercial users who profit from the system must be made concrete and binding in the text of the Agreement. This must be agreed upon upfront and not deferred to subsequent bilateral talks between WHO and manufacturers, as rich countries have suggested.

Holding these negotiations once a crisis is underway is not only a tactical mistake but also inconsistent with the text of Article 12, which requires that access and benefit sharing be secured on an equal footing. This means that a percentage of VTDs must be guaranteed not only once a pandemic is declared, but set aside for stockpiling during interpandemic periods and for deployment once a PHEIC is declared—as has happened several times since the pandemic, in the case of mpox in 2024, for instance, and in May, for the Ebola Bundibugyo virus outbreak in the Democratic Republic of Congo.  

It also means ensuring pre-negotiated licenses, the transfer of technology and know-how that let developing countries produce for themselves rather than wait for donations, and annual contributions from participating manufacturers and others who profit from the use of the PABS System.

HIV showed what waiting costs

International AIDS Conference “Keep the Promise” march in Durban, South Africa, led by AIDS Healthcare Foundation in 2016 – 14 years after AHF opened its first international clinic -as low-income countries belatedly gained access to ARVs.

The debate over PABS echoes lessons learned from the global HIV/AIDS response. In the late 1990s and early 2000s, lifesaving antiretroviral medicines transformed HIV from a death sentence into a manageable chronic disease—but only for those who could afford them. While people in high-income countries gained access, millions in low- and middle-income countries continued to die as treatment remained out of reach.

It took years of grassroots advocacy, political leadership, voluntary licensing, generic competition, and unprecedented international cooperation to expand access and begin closing that gap. The world should not repeat the mistake of treating equitable access as an afterthought. If countries are expected to share the pathogens that make medical breakthroughs possible, then the benefits of those breakthroughs must also be shared in a timely, predictable, and equitable manner.

A public good cannot rest on unequal obligations

Meeting of the Intergovermmental Working Group (IGWG) on a PABS annex in March, 2026

The Pandemic Agreement should therefore be understood not only as an instrument of global health security, but as a global public good. Its value depends on being available to all countries, because the benefits of early detection, rapid sharing of information, timely access to medical countermeasures, and stronger regional capacities cannot be confined within national borders. But a global public good cannot rest on unequal obligations. If all countries are expected to contribute to collective protection by sharing pathogens and data, then all countries must also be guaranteed fair, timely, and enforceable access to the benefits that such sharing makes possible.

No country can wall itself off from a pandemic. This is perhaps the last chance the world has to address the systemic inequality in the current global public health order for a long time. Giving in to pressure from corporate interests and profit motives at this point is beyond foolish. If we fail to enshrine equity as a fundamental principle of global public health, all countries will be forced to pay many times over. That is why an equitable Pandemic Agreement must be treated as a true global public good. The negotiations have been long, difficult, and contentious. Developing countries should not shy away from standing for what is right, while developed countries must find the wherewithal to do the right thing.

Mokgweetsi Masisi is the former President of Botswana (2018-2024) and a member of the Club de Madrid.

Michael Weinstein is the President of the AIDS Healthcare Foundation (AHF).

 

 

Image Credits: Delthia Ricks/Twitter, Gerald Barber, Virginia Tech (with permission of the National Science Foundation), UNICEF, AIDS Healthcare Foundation , WHO / Mark Nieuwenhof.

Millions of people are facing physical, emotional and financial toll of cancer, finds latest WHO report.

By 2050 there will be 35 million cancer cases annually – a 66.7% increase in incidence from 2024.

That is, unless urgent action is taken to improve prevention and access to early diagnosis and treatment, according to a report released Wednesday by the World Health Organization (WHO).

Currently, cancer kills 26,000 people daily and is the second leading cause of death after cardiovascular disease. Fewer than one in three countries include cancer care in their universal health coverage (UHC) packages.

Presently, there are an estimated 20.6 million new cases and close to 10 million deaths annually.

A silver lining is that key policy interventions have led to a 27% decline in tobacco use worldwide since 2010, contributing to reductions in lung cancer cases and deaths in some regions.

But other key preventive measures, including obesity, infections and obsessive alcohol consumption need more assertive action – along with even more progress on tobacco.:

These are the takeaways of the Global Status Report on Cancer 2026 jointly developed with the International Agency for Research on Cancer (IARC).

“Cancer is a deeply personal disease that touches nearly all of us. But whether a person survives cancer should never depend on where they were born or what they earn,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus.

Cancer remains a global health priority.

According to the report, based on data from 2024, “the leading contributors to cancer cases globally were tobacco use, infections, alcohol consumption, and high body-mass index (BMI) accounting for 15%, 10%, 3% and 2% of all new cancer cases, respectively.”

The report also highlights persistent inequities in access to timely cancer diagnosis and treatment.  While 87% of women with breast cancer survive five years after their diagnosis in high-income countries, only about 42% do so in low-income countries, the report finds.

In terms of infections, human papillomavirus (HPV) is a leading cause of cervical cancer – another leading killer of women in low-income countries who lack access to regular cervical cancer screenings. While HPV vaccine uptake has increased, there are still wide gaps in coverage especially in large parts of Africa, the Middle-East and Asia.

“The inequities documented in this report are not inevitable; they are the consequence of choices, and they can be reversed through stronger and unified action,” Tedros said.

The report is the first comprehensive analysis of the global status of cancer prevention and control, projections of future trends – and progress made since 2010, the baseline year chosen for the analysis.

Along with the progress seen on tobacco, alcohol consumption has fallen, but only marginally, and screenings for breast as well as cervical cancer have improved in both high and low-income countries.

Asia, Europe have large cancer burden

Global incidence of cancer by continent in 2024.

In 2024, Asia accounted for the largest share of cancer cases, with more than half of all cancer cases (50.7%) and deaths (56.5%), reflecting its large population. 


Europe too carried a disproportionately high burden, contributing 21% of global cases and 20% of deaths despite having only about 9% of the world’s population. In contrast, many countries in Africa and parts of Asia experience lower incidence but disproportionately high mortality. 

Nearly four in ten cancer cases globally are linked to preventable risk factors, particularly infections such as human papillomavirus (HPV), hepatitis B and C, and helicobacter pylori, alcohol, tobacco use, high body mass index and insufficient physical activity, highlighting the critical role of prevention. 

Not all preventable risk factors are receiving enough attention, experts noted.

“For obesity, for example, a lot of the prevention strategies that exist today have been implemented or taken in high-income countries, mainly, while in the low and middle-income countries, we see the take-up of these programmes are then much less,” Dr Isabelle Soerjomataram, Deputy Head of the IARC Cancer Surveillance Unit said, speaking at a press conference to launch the report.

Gendered impact of the disease

While lung cancer is the most common form of cancer in men, it is breast cancer in women.

Among the different types of cancer, lung cancer remains the leading cause of cancer death globally.

Overall, lung, prostate and colorectal cancers are among the most common cancers in men, while breast, lung and colorectal cancers account for a substantial share of the burden among women. 

Cancer still carries stigma, especially for women.

“After my own double mastectomy, I struggled with body image, but I knew that that surgery had given me the best chance at life. Yet I met four women who chose to die rather than lose a breast to breast cancer. That is the devastating power of stigma,” said Abigail Simon-Hart, a breast cancer survivor and patient advocate.

Experts drew attention to the impact on men as well. “There’s also the very real impact of cancer on men, and that age-standardized incidence rates for cancer in men is higher, and many men are also being left behind,” said Dr Andre Ilbawi, Team Lead for Cancer Control, WHO.

Major gains but gaps persist 

Patients listen as a staff nurse explains the screening process before they register to be screened for breast and cervical cancer at the RAiSE Foundation center in Niger State on 23 February 2021.

The report notes substantial gains in key policy areas. Apart from the decline in tobacco use contributing to the reduction in lung cancer cases and deaths in some regions, infection-related cancers are also decreasing thanks. This is due to the expanding vaccination coverage and improved water, sanitation and hygiene (WASH) as well as infection prevention and control.

Around 82% of countries now have national cancer control plans, up from 50% in 2010.

In high-income countries, early detection programmes catch most breast cancers and 74% of women have been screened for cervical cancer.

Scientific innovation is accelerating; registered clinical trials have increased at an annual rate of 7.3% between 2005 and 2021.

But essential cancer medicines remain out of reach for many. Availability of the top 20 priority cancer medicines ranges from just 9% to 54% in low- and lower-middle-income countries, compared with 68% to 94% in high-income countries. And the consequences of these gaps are felt most acutely by people living with cancer and their families.

Toll on caregivers, community

Dr Andre Ilbawi, Team Lead for Cancer Control, WHO

Cancer care remains financially and socially devastating for many households.

At least 45% experience financial hardship, more than half report mental health challenges, and nearly all caregivers report strain including unpaid services and social isolation, the WHO’s first-ever survey of people affected by cancer found that covered 4,000 people across 116 countries.

“To succeed against cancer, we must continue to focus on technological innovation, and we must also create the conditions that empower and care for people more holistically,” Ilbawi said.

Image Credits: WHO/Yasin Abdullahi, Unsplash/National Cancer Institute, Global status report on cancer 2026, Etinosa Yvonne/WHO.

Hadiza Barwa, a Community Health Extension Worker trained under the TSTS project, checks on the progress of a pregnancy in Gwale Primary Healthcare Centre in a suburb of Kano, Nigeria.

A Task Shifting/Task Sharing investment in Kano State in Nigeria is empowering community health workers and improving maternal and newborn outcomes

KANO, Nigeria – It is antenatal day at Gwale Primary Health Care Centre (PHC) in the suburbs of Kano, the capital of the state by the same name and the second biggest city in Nigeria.

Hadiza Barwa, a Community Health Extension Worker (CHEW), is in a small consulting room with Saádatu Ado, who is pregnant with her fourth child. The blood pressure check has been done in another room.

Now it is Barwa’s turn. She palpates the abdomen carefully, measures with tape, and looks up. “The foetal heartbeat is normal,” she says. “The pregnancy is measuring around 28 weeks.”

Ado smiles. Barwa smiles back. Then comes a quiet one-on-one covering nutrition, hygiene, what to watch for, and when to come back.

“I did my previous three antenatal visits at a hospital far away from this community,” Ado says as she walks out of the room. “The attitude of health workers here has improved tremendously. That is why most of us, the pregnant women in this community, are now accessing antenatal care and delivering in this facility.” 

She is looking forward to delivering her fourth child here – at a PHC not too far away from her front door.

Addressing health worker shortages

Ado is one of hundreds of pregnant and breastfeeding women who have shifted to Gwale PHC in recent months. The shift is not accidental.

Nigeria’s doctor-to-population ratio stands at 2.9 per 10,000 people. Its nurse-and-midwife ratio is 1.6 per 1,000. Most of those higher cadre health workers are concentrated in secondary and tertiary facilities in cities. 

For a pregnant woman in a rural or semi-urban community, the nearest qualified clinician can be hours away, which is precisely where the risk accumulates. 

Kano State, the second most populous state in Nigeria, has some of the highest maternal mortality rates in the country. In certain Local Government Areas (LGAs) within the state, the figure exceeds 1,000 deaths per 100,000 live births.

Against this backdrop, Nigeria enacted a national Task-Shifting, Task-Sharing (TSTS) policy in 2014, formally expanding what CHEWs are permitted to do. 

The policy has existed for more than a decade. However, making it work at the facility level is a different matter. That is the problem the TSTS investment set out to solve. 

Implemented by Impact Catalysts and Pathfinder International Nigeria, in collaboration with the Kano State Primary Health Care Management Board (KNSPHCMB) and with support from the Gates Foundation, the investment has been running since November 2024 across 145 primary health care facilities in 26 LGAs in Kano State. 

Its aim is straightforward: train and mentor CHEWs to safely provide selected maternal and newborn health services that previously depended on the availability of nurses or midwives.

Complete package of pregnancy care

Hafsat Yahaya has worked at Jaen PHC for 18 years. For most of that time, she was an environmental health assistant, important work, but a long way from the consulting room and further still from the labour ward. 

She believed she could do more,  so she enrolled in a School of Health Technology, qualified as a CHEW five years ago, and has been providing care to her community ever since.

When the TSTS investment arrived at Jaen PHC, Yahaya was nominated by her colleagues to receive the clinical training. 

The training, which ran for more than a week, covered Basic Emergency, Maternal, Obstetric and Newborn Care (BEmONC). This included the prevention, detection and management of postpartum haemorrhage using the E-MOTIVE bundle, management of pre-eclampsia, infant resuscitation, the use of a partograph to monitor the progress of labour, comprehensive antenatal assessment and counselling, postpartum contraception and neonatal vaccination.

It was, in the words of one implementation staff member, a complete package, from the first antenatal visit to postnatal care.

Hafsat Yahaya (right) helped deliver Hassana Umar’s six-week-old daughter in Jaen Primary Healthcare Centre.

Yahaya’s first real test came quickly. A woman was brought to the facility convulsing after delivering at home. Yahaya recognised the signs of eclampsia. On a normal day, Yusif Adamu, the facility in-charge, says, they would have referred the woman immediately to a higher facility. There was every chance she would not have made it. 

“Hafsat stabilised the woman by administering magnesium sulfate before we referred her,” Adamu says. “Since then, she has been a star in this community. People believe she has special skills, and that has attracted many more pregnant women within the community to deliver at this facility”

Yahaya now has a permanent post in the labour room at Jaen PHC. She has delivered many babies. She has prevented and managed postpartum haemorrhage and stabilised women with pre-eclampsia. She has also been running step-down training sessions for her fellow CHEWs at the facility, passing on what she has learned, multiplying the effect of the investment.

It is immunisation day at Jaen PHC, and Yahaya is holding a six-week-old baby. The infant’s mother, Hassana Umar, brought her daughter for vaccination and came to see Yahaya specifically so she could see the child she helped deliver.

 “Hafsat held me throughout the labour until I delivered,” Umar says. “She encouraged me and supported me to walk around the labour room. When I brought my baby for vaccination today, I had to bring her here. I wanted Hafsat to see her.”

Skills and supplies 

The investment does not stop at training. A CHEW who knows how to manage postpartum haemorrhage but has no uterotonics on the shelf is in an impossible position. 

Impact Catalysts and Pathfinder International Nigeria have been working with the KNSPHCMB to ensure that the medications and equipment that CHEWs are now trained to use are available in the facilities where they work.

That list includes magnesium sulfate for eclampsia, the E-MOTIVE bundle for postpartum haemorrhage prevention and management, chlorhexidine gel for cord care in newborns, and manual vacuum aspiration (MVA) kits. For a CHEW at a rural PHC, each item on that list represents a situation that used to end in a referral, and all the uncertainty that came with it.

Safiya Ibrahim is a CHEW at Dawakiji PHC. She has been through the TSTS training and is now under ongoing mentorship. 

“There is nothing as painful as not being able to help a pregnant woman or newborn in distress,” she says. “I have been in situations here where we had to refer women, and we would not know what became of them on the way to a higher facility. I would go home thinking about whether they made it or not.”

That is no longer her reality. Ibrahim has delivered babies, managed PPH, handled retained placenta, and resuscitated newborns. 

She recalls a non-responsive newborn brought to the facility after being delivered at home. Working with her colleagues, she resuscitated the infant. 

She recalls a woman with a retained placenta; she applied the uterine massage and controlled cord traction techniques she had practised in training, the placenta came away, and the bleeding was controlled. 

“We now know how to monitor the progress of labour using a partograph,” she says. “We know how to prevent and manage complications. We know when to refer.” 

There have been no maternal or neonatal deaths at Dawakiji PHC since August 2025, when Ibrahim underwent the training and returned to provide services at the facility.

Mentorship is what makes it stick

Community health extension worker Hafsat Yahaya with Yusif Adamu, who is in charge of Jaen Primary Healthcare Centre.

The training is the foundation. The mentorship is what makes it stick. The TSTS investment engaged 26 senior nurses and midwives, each with decades of clinical experience, to serve as mentors across the 26 LGAs where it operates. 

Each mentor is assigned to one LGA and rotates through the facilities in their area, observing CHEWs at work, assessing their skills, and providing continuous hands-on coaching.

This is a different model from a one-off training followed by a certificate and a return to the status quo. It is designed to build competency over time, to catch mistakes before they become harmful, and to give CHEWs the kind of structured support they need to use new skills safely. The mentors are not supervisors in the traditional sense. They are clinical teachers, showing up at the facility and working alongside the health workers they are developing.

What comes next?

As the investment approaches the end of its implementation period, the question of what comes next is unavoidable. The 145 facilities, the 26 mentors, the medications and equipment, the step-down training sessions have been running on the investment support. What happens when that support ends?

Prof Salisu Ahmad Ibrahim, the executive secretary of KNSPHCMB, is direct about what the Kano State government is taking on: “The improvement we have seen is across board, from documentation to the management of haemorrhage and eclampsia, to referral. It is a testament that the investment has succeeded,” he says. “Even after it rounds up, the state government will take it over and sustain it.”

He offers specifics. From 2027, the state will make budgetary provisions for TSTS implementation and sustainability. As Impact Catalysts and Pathfinder International Nigeria prepare to exit, the Board is planning to wholly take up the initiative. Already, the Board proposes recruiting 18 additional mentors, bringing the total to 44, one for each LGA in the state. These are meaningful commitments. They are also exactly what an investment like this depends on if the gains it has made are not to evaporate the moment the funding cycle ends.

Back at Gwale PHC, Saádatu Ado is preparing to leave. Her blood pressure is good. The baby is in the right position. She will be back in four weeks. 

Three previous pregnancies, three long trips to a hospital that felt far from everything. This one is different. She has been coming here from the beginning, seen by Barwa, whose hands she now trusts. 

She will deliver here, in the community where she lives, attended by a health worker who was trained and mentored and equipped to do exactly this.

That is not a small thing. In Kano State, where the road between a PHC and a hospital can be the difference between a woman surviving childbirth and not, it is the whole thing.

 

Image Credits: Bashar Abubakar/ Impact Catalysts.

The Global Fund has helped to save more than 70 million lives suffering from AIDS, tuberculosis and malaria across the globe.
The Global Fund has helped to save more than 70 million lives suffering from AIDS, tuberculosis and malaria across the globe.

The election of the new executive director for the Global Fund to Fight AIDS, Tuberculosis and Malaria will move forward on schedule, according to a statement released by the organisation on Tuesday, 7 July. This announcement follows rumours that the nomination process might be restarted after the names of several US candidates who were reportedly shortlisted had been disclosed to Health Policy Watch

The roster reportedly omitted a German-backed applicant, sparking frustration in European countries, particularly in Germany, a major donor to the Global Fund.  See related story.

EXCLUSIVE: US Candidates Among Those Shortlisted in Contentious Global Fund Leadership Race

Also on Tuesday, the Trump administration confirmed that it will not impose its expanded global gag rule or other funding conditions on its contributions to the Global Fund, according to a Devex report. The expanded rule, adopted by President Donald Trump last year, restricts the use of US funding not only for abortions but to global health programmes that promote diversity, equity and inclusion – language that hits at the very DNA of most global health initiatives.

Calls for more transparency

Because the multibillion-dollar agency relies heavily on taxpayer contributions to procure lifesaving medicines, some critics have maintained that the Global Fund leadership race should be conducted in a more transparent manner.

Defending its restrictive protocols, the Global Fund statement contended that absolute confidentiality is essential to protect the privacy of high-profile applicants and safeguard the integrity of the proceedings by the Executive Director Nominating Committee (EDNC).

“The Global Fund remains committed to a merit-based, transparent and well-governed selection process that protects the confidentiality of candidates while enabling the Board to identify the strongest possible leader for the organization,” the statement said.

“The names and biographies of the final shortlisted candidates will be published on the Global Fund website once it has been submitted to the Board. Until that stage, candidate information and committee deliberations will remain confidential to protect the integrity of the process, ensure fairness to all candidates and support open deliberations by the EDNC. Other than the final candidates, all other candidate names remain confidential indefinitely,” the statement added.  A final shortlist of “four to five candidates” should be submitted to the Board in late September, the statement added.

The strict confidentiality rules stem from a costly historical precedent, supporters of the process say.  During the 2017 leadership transition, the institution was forced to completely restart its executive director search after leaks to the media.

Nomination schedule on track

As the Global Fund grapples with a massive $5.36 billion funding shortfall for the next grant cycle, the selection procedure unfolds against a highly challenging financial and geopolitical backdrop.

Moving forward, successive rounds of confidential interviews and due diligence assessments are narrowing the applicant pool behind closed doors.

First-round interviews will take place next week, from 12 to 23 July in London, followed by second-round interviews in early September to finalise the shortlist. The finalists will attend a retreat on 1 and 2 October, followed by several weeks of “engagement with Board constituencies” before the Board convenes to make a final decision.

Final appointment of the incoming executive director will then occur during the 56th board meeting in Geneva from 28 to 30 October 2026.

Assuming office during the first quarter of 2027, the newly elected Executive Director must immediately navigate a fractured donor landscape and geopolitical rifts to continue the vital work of the organisation.

New Funding Models Needed as Global Health Faces Growing Financial Strain

Image Credits: European Union.

Delhi’s chief minister, Rekha Gupta (centre) at the announcement of the new EV policy late last month.

After years of stonewalling, the city is finally acknowledging the public health risks of air pollution – launching a major initiative to clean up emissions from the capital’s 10 million vehicles, along with stricter curbs on waste, construction and traffic during winter-time pollution peaks. The most radical measures include: banning new fossil fuel–powered 2 & 3-wheelers and small trucks and ending support for hybrid cars while offering heavy subsidies for “pure” electric vehicles only. Can the measures finally trigger real change?

NEW DELHI – Air pollution has made the headlines in Delhi unusually for the city’s summer season when levels are typically low. The government has announced a series of new policies worth approximately $2.5 billion to improve the quality of air in the world’s most polluted capital. 

There are three major new initiatives. These include a new $1.5 billion Delhi EV policy on July 1; a $1 billion plan to replace old, polluting trucks and buses in Delhi and its suburbs; and mandatory curbs on transport into Delhi, staggered office timings, 50% work-from-home mandate, and other measures between November 1 and February 28, which is the region’s peak pollution season. 

While policy action is centred on Delhi, potentially any other state or city in India – where two-thirds of the world’s 100 most polluted places are located – could use this as a template for adopting similar emissions curbs.  A common thread across the measures is the unequivocal acknowledgement by the government of the link between fossil fuel emissions, air pollution and health. As Rekha Gupta, Delhi’s Chief Minister, said in a social media post, “We want the policy to, step-by-step, help convert Delhi into a pollution-free city.”

EV policy: What’s in, what’s out

Delhi’s EV Policy 2.0 bans new fossil fuel three-wheelers and small trucks, which are the backbone of last-mile delivery of goods, from January 1, 2027. And then, from April 2028, no new fossil fuel two-wheelers will be allowed. Only electric. Two-thirds of Delhi’s 8.7 million vehicles are two wheelers. In terms of the car fleet, meanwhile, financial incentives for hybrid gasoline and electric vehicles also are being terminated.

But there’s a carrot along with the stick.  A series of new subsidies for electric two- and three-wheelers, as well as other types of light goods electric vehicles has been established. 

Subsidies for the purchase of electric cars are also being maintained and even increased, ranging from about $1,000 to 10,000 per vehicle, depending on vehicle type and tapering off over time. 

Delhi’s new EV policy will also include a 100% exemption on road tax and registration fees for electric cars priced up to ₹30 lakh (about $30,000). And vehicle owners who scrap older, more polluting cars and trucks will receive financial incentives of up to $50. 

Electric vehicle being charged in Delhi.

For the light vehicle and car fleet, the focus going forward will be on “pure EVs” as one official put it. 

The government says the policy will cost about $1.5 billion, including subsidies and other tax breaks as well as the cost of new EV infrastructure. At the moment, there is no plan to actually ban conventional gasoline or diesel-powered cars, Gupta has stressed. Rather, the government’s focus will be on incentivizing EVs through the subsidies and tax relief.  

Over time, however, the government may introduce further electrification mandates for different elements of the vehicle fleet, as well as developing a framework to “discourage” the registration of polluting vehicles running on “inefficient fuels”.

Government acknowledges vehicle pollution’s contribution to health risks

Colorfully decorated Delhi freight truck belies its heavy pollution emissions load.

The new policy aims to achieve at least 30% electrification of Delhi’s vehicles by 2030.

This followed a frankl government acknowledgement in June that  air pollution in Delhi-National Capital Region (NCR) remains a “severe public health challenge” particularly during winter months. 

Transport is the single largest pollution source within the city. And vehicular emissions contribute around 23% of Delhi’s PM2.5 during the peak winter months of smog. 

Two-wheelers, which represent  two-thirds of Delhi’s vehicle fleet, contribute to about one third of vehicle emissions of  PM2.5 (a fine pollutant) that penetrate the lungs and into the blood stream and are thus the most health harmful, according to an IIT Kanpur study. This is even more than the emissions from three-wheelers.

Phase out of most polluting diesel trucks

Ministry of Road and Transport official, Mahmood Ahmed, hosts launch of the report ‘Towards Cleaner Freight in Delhi’.

A few weeks before  Delhi’s EV policy announcements, the central government also announced an INR 9,585 crore (almost $1 billion) scheme to replace 200,000 older, and highly-polluting diesel trucks over the next two years in the Delhi region, although it exempted government vehicles. 

The key in this policy is replacing vehicles that fail to meet the newest Indian government emission standard of Bharat Stage 6, equivalent to a Euro 6. 

While electrification of Delhi’s bus fleet is already advancing apace, the Delhi policy stops short of mandating a switch to zero emission heavy duty freight vehicles. 

But a brand-new report on truck pollution in the Delhi region by three prestigious think tanks calls for moving in that direction.

The report, ‘Towards Cleaner Freight in Delhi’ calls for 100% of freight trucks to be electrified by 2035. The report  was produced by the Air Pollution Action Group (APAG),  Indian Institute of Technology Delhi (IIT Delhi), and The Energy and Resources Institute (TERI). The report was publicly launched last month by a senior Ministry of Road and Transport official,  Mahmood Ahmed – reflecting the attention the recommendations are getting in government circles. 

Heavy duty vehicles contribute disproportionately to air pollution

Proportion of vehicle emissions by type of vehicle show heavy duty vehicles (trucks) have an outsized influence.

Delhi’s proposed EV measures are among the most ambitious state-level initiatives to improve air quality by accelerating the transition to zero-emission vehicles (ZEVs), Amit Bhatt, India Managing Director of the International Council on Clean Transportation told Health Policy Watch. 

Electrification of the truck fleet, however, remains a significant gap that still needs to be addressed by the Indian government, he said. 

Heavy-duty vehicles contribute far disproportionately to harmful air pollutants despite being a small share of the vehicle fleet, Bhatt pointed out. In Delhi, trucks contribute nearly a quarter of vehicle pollution emissions throughout the day, but 75% at night. 

At a national level, while medium-and heavy-duty vehicles account for only 3% of the total vehicle stock, they contribute up to 53% of particulate matter emissions from transport nationwide.

 “These measures can significantly reduce emissions from the transport sector and set an important precedent for other states,” Bhatt said. “But Delhi alone cannot eliminate its air pollution; it needs a regional approach. 

As part of that,  freight emissions is “critical,” Bhatt added, saying that the ICCT which works with the government, supports a coordinated regional strategy, including accelerated electrification of interstate freight trucking asl be essential to deliver sustained improvements in air quality across Delhi and the wider region.

Government pledges tougher enforcement of emissions standards on older vehicles 

Older vehicles in Delhi tend to be much more highly polluting, contributing more than a third to ambient air pollution levels.

Another looming challenge remains the enforcement of pollution control standards on fuel-powered vehicles that remain on the roads. Every fuel-powered vehicle on the road must obtain a Pollution Under Control Certificate (PUCC). 

Currently,  the system is plagued with problems -including lax monitoring, and related to that,  allegations of corruption, as well as a lack of more advanced monitoring of key pollutants such as PM2.5 and oxides of nitrogen (NOx) that are the most lethal for health. 

At the launch of the recent IIT-TERI truck report, Ahmed of the Transport Ministry announced that the PUC system would be reformed ahead of Delhi’s peak pollution season. 

“We’ll definitely tighten up the processes. We’ll ensure that the gaming that is happening now, in terms of the vehicle not reaching the centre itself, in terms of the data being manipulated,” Ahmed told Health Policy Watch on the sidelines of the launch. 

While he didn’t go into details, some of the changes under consideration include geo-tagging of vehicles at testing centres, end-to-end encryption of emissions data, mandatory insertion of the testing probe into the vehicle tailpipes and eliminating manual entry of emissions data to reduce manipulation.

However, the reforms do not include testing vehicles for the hazardous PM2.5 and NOx. While such tests are readily available in developed countries, in India the technology is currently more expensive, Ahmed said.  

As Ahmed told Health Policy Watch. “There are technological challenges. As you must understand, these are fine particles. They can even go through the pores of the skin and skin and reach your lungs….More importantly, there’s a cost challenge to it. So [the question is] whether a simple device, located in a small PUC (test) centre, can be that advanced?”

‘Master plan’ to further curb Delhi’s emissions  in peak season

Delhi under winter smog. Along with vehicles, construction dust, coal power generation and household heating are factors.

The Delhi government has also announced a list of mandatory curbs and rules to be implemented between November 1 and February 28 of every year, starting this year. This is the peak pollution season. 

Called the Winter Pollution Master Plan, the measures include: 

  • No fuel sale for vehicles without a valid Pollution Under Control (PUC) certificate around the year.
  • No entry in winter of non-Delhi registered gasoline and diesel vehicles with emissions above  BS/EURO 6  emission standards, except for CNG and electric vehicles, ambulances, fire services and other essential vehicles.
  • Doubling of parking meter charges.
  • Half the employees at government and private offices working  from home on any given day of the week.
  • Office hours  will be staggered to reduce peak-hour traffic congestion.
  • No demolition work and open dust-generating construction activities will be prohibited, except for essential public infrastructure projects.
  • Installation of anti-smog guns (water sprinklers) at large commercial buildings and major construction sites.
  • Stricter curbs on open burning of waste; institutions and neighbourhood welfare associations to be held accountable.
Punjab – Crop waste burning in northern India’s rural areas during late autumn to hasten planting sends volumes of smoke towards Delhi, the nation’s capital.

With the exception of some tweaks, these winter-time curbs are not new. Yet, Delhi’s pollution levels in the peak winter period have  remained extremely hazardous. Data from Centre for Research on Energy and Clean Air (CREA) shows how the October to December PM 2.5 levels have remained at or above 170 micrograms/cubic metre, that is 34 times above WHO’s recommended safe levels, for nine of the past ten years.

Moreover, multiple studies have revealed that almost two-thirds of Delhi’s peak winter time air pollution drifts into the city from surrounding states, well outside the small state’s own boundaries. A leading factor here, is crop waste burning in surrounding rural regions of Punjab and Haryana state – producing smoke that drifts to the city and then hovers over it for days, in the dry season. 

On paper, the national government has adopted an airshed approach, that is, coordinated policy action across multiple state and district jurisdictions in a common geography where the air tends to get trapped. But this approach has clearly had limited success. 

So, the crackdown on polluting vehicles is a radical move for Delhi; it is a benchmark for the rest of India. 

But as one group of concerned parents quickly pointed out, the measure are unlikely to be sufficient if pollution isn’t reduced from other sources – including households, industries, waste and farm fires in surrounding rural regions. “Our response”, concluded the Parents group, is “not good enough.”

 

Image Credits: Chetan Bhattacharji, Delhi State , Chetan Bhattacharji, A-PAG , A-PAG, A-PAG, Raunaq Chopra/ Climate Outreach, Neil Palmer.

Climate-linked migration and displacement affect health in multiple pathways. A new WHO research initiative in the Western Pacific Region aims to find out more.

WHO’s Western Pacific region, the agency’s most populous, is home to nearly two billion people, including some small island nations like Fiji, Tuvalu and the Marshall Islands whose very existence is threatened by climate change.

And yet, no one really knows how many people are on the move due to climate-related extreme weather events that are eroding coastlines, encroaching on communities and curbing traditional economic activities, triggering displacement and migration in small island states and beyond.

To address such gaps, the World Health Organization’s Western Pacific Regional Office recently launched a research agenda asking countries in the region to track such movements, amongst a host of other climate-related health risks.

Central to the initiative is the understanding that climate change, migration or displacement and health are intrinsically linked, said Sandro Demaio, Director of the WHO’s Asia-Pacific Centre for Environment and Health (ACE), in a webinar launching the initiative on Monday.

“Despite the growing recognition that these interconnected issues exist and are playing out in real time, important knowledge gaps remain. We still need a better understanding, more clarity, more commitment, more depth of how climate change influences patterns of migration and displacement, and how these dynamics affect health outcomes,” Demaio said.

The agenda is meant to push countries to create sound evidence, allocate finances and design effective interventions as they draft their national climate and health policies.

In focus: Western Pacific and Asia region


Currently, most studies come from high-income settings. Apart from that, “limited evidence exists on anxiety, trauma, depression, and resilience among people displaced by climate-related events,” said Dr Santino Severoni, Head, WHO Health and Migration.

“More research is needed on children, older adults, pregnant women, people with disabilities, and Indigenous communities affected by climate,” he added.

Push to focus on health of migrant and displaced populations

WHO has released a health and migration research roadmap for the countries in the Western Pacific region.

Recognizing that the Western Pacific region is a large one, WHO has tweaked the agenda to make it more tailored to the Pacific as well as the Asia sub-regions, respectively.

For the Pacific region, the WHO has asked countries to focus on research on cultural loss as the small-island states battle for their survival.

“In the Asian sub-region, the report flags visa status and labor exploitation as major under-research commercial determinants,” said Brian Hall, Director of the Center for Global Health Equity, NYU Shanghai.

Also read: As El Niño Intensifies – WMO Warns Policymakers to Brace for Escalating Impacts on Health Worldwide

Health of migrants central to delivering universal healthcare

WHO has released a health and migration research roadmap for the countries in the Western Pacific region.

Within migrant communities, as well, there are particularly vulnerable sub-groups, including entirely stateless populations, as well as women, children and older people, who may be disproportionately hit.

“Most countries don’t disaggregate health data by migration status, so we’re flying blind on maternal and child health, immunization, and chronic disease in micro populations,” Hall said.

A key WHO ask of the countries is that they also empower communities to lead the research.

“First and foremost, involve the communities from the beginning when the research questions are defined, not only during the data collection. Second, I would say recognize the lived experience of young people as their expertise, because young people in communities on the move should help shape the evidence and inform the policy priorities,” said Salsabila Rashid, youth representative of the New York – based civil society group, Migration Youth and Children Platform.

Image Credits: WHO/Yoshi Shimizu, WHO, WHO.

The World Health Assembly plenary where the historic Pandemic Agreement was approved. It cannot come into effect until the PABS annex is agreed.

The Pandemic Agreement talks resumed at the World Health Organization’s (WHO) headquarters on Monday, kicking off with a public “debriefing” summarising the incremental progress made during informal talks conducted over May and June, followed by a closed session on existing models for sharing data on pathogens with pandemic potential.

Speaking at the opening of the session, WHO Director Dr Tedros Adhanom Ghebreyesus urged member states to keep two simple end goals in sight. Those include: “A future in which pathogen samples and information move quickly, without needless delay; and in which the benefits that come from them reach the people who need them most, fairly and in time.

“The differences that remain are real. They matter to the people you represent, and I respect that,” Tedros added. “But they are not impossible to bridge. So I ask you: focus on what truly matters. Don’t let the urgency fade.”

Detailed summary presented at the resumed PABS negotiations Monday reflects slow, but incremental progress on the many outstanding technical issues.

While those close to the talks confirm that slow progress is being made, this 10-day negotiating session (which ends 17 July) is unlikely to result in an agreed pathogen access and benefit-sharing (PABS) system just yet.

Wide differences remain with regards to how a standardized system for both pathogen registration and eventual benefit-sharing of R&D products could be created and enforced, in light of the multiple approaches being used in reality today.  Those differences – as well as potential bridging solutions – were vividly on display again Monday as member states and observers shared their experiences.

Pathoplexus, the database where the gene sequence for the Ebola Bundibugyo virus was first shared, pointed to the staged data-sharing approach to used by the Uganda-led team that first sequenced the pathogen as an example of a hybrid solution.

Pathoplexus representative addresses the PABS meeting Monday.

“They initially chose a time-limited restricted use option, making data fully open for public health analysis, phylogenetics, and output tools immediately, while protecting the right to publish first,” Pathoplexus noted. Then last week, following publication in a scientific journal, the same data was released “to fully open status,” he said.

“Our current model does not yet solve the question of access and benefit from commercial use, but that question matters urgently. The rapid development of vaccines, diagnostics, and treatments is crucial for outbreak response, and should be facilitated by clear, standardized, and agreed terms,” the Pathoplexus representative stated.

Meanwhile, the South Centre expressed skepticism about a PABS agreement that might embrace too much diversity to pathogen registration and sharing.

“We do have some concerns with some ideas about hybrid approaches,” the delegate stated. “We think that the standardization of the of the way the design of the PABS system is done is essential. Otherwise, this will create other uncertainties and more difficulties, in particular with the reference to what obligations member states will take. We think it’s essential that … the whole system is built on the basis of standard contracts, also to ensure what are the means that member states themselves can, through their own legislatures, support that contractual structure.

“We see that there has been the clear textual line on access stating an obligation for member states to facilitate rapid access. At the same time, you can have provisions domestically to facilitate benefit sharing …..ensuring that benefit sharing from any commercial use requires this payment to the system that goes to the multilateral tax fund. ”

Linkage or not ?

Pharma leaders, meanwhile, stressed that any pathogen sharing system should be “grounded in outbreak reality”  and aim to “reduce rather than increase both legal uncertainty and the restrictions that could delay scientists’ ability to access and use pathogen data.

“We share the objective of ensuring equitable access to medical countermeasures and companies have demonstrated this commitment repeatedly through proactive and voluntary engagement across public health emergencies, including COVID-19, mpox, and Ebola,” said a representative for the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). “However, introducing a cumbersome PABS system will not improve preparedness or access outcomes. In practice, the main bottlenecks have consistently been related to financing, regulation, and delivery – not supply.

“Looking ahead, it is critical that we do not jeopardize the progress achieved in the Pandemic Agreement, including the set-aside mechanism, by introducing a PABS system that is impractical for research and potentially counterproductive. Instead, we should build on existing mechanisms that already enable rapid, open, and effective data sharing, including established international databases, while ensuring that countries are supported and enabled to operationalize agreed access provisions.”

Equity provisions triggered by product registration

Geneva representative, Thiru Balasubramanian delivers KEI’s proposal for two core paragraphs for the PABS annex at Monday’s meeting.

Finally, Knowledge Ecology International suggested that two simple paragraphs should form the core of the final PABS text – clearly committing states to enforce the medicines/vaccines access and equity provisions of the Pandemic Agreement – but without creating any direct linkage to the way pathogen data is accessed for R&D purposes.

“For some time, KEI has taken the position that equity provisions should not be linked to access to PABS materials or data, that governments joining the treaty should be responsible for enforcing the access/equity provisions, and that those provisions should be triggered by the registration and sale of products, not access to information,” said James Love, head of KEI, in a statement on Sunday.

“This is how we suggest it be done, in two short paragraphs,” he added, setting out the first paragraph of the Annex as stating that:

“Each party [to the agreement] shall take all necessary legal, administrative, or regulatory measures to ensure that any manufacturer seeking to register or sell pandemic-related products within its jurisdiction provides verifiable evidence of a legally binding agreement with the World Health Organization (WHO) that addresses access to such products, consistent with Article 12, Paragraph 6, of the Pandemic Agreement.”

Article 12, paragraph 6  stipulates that manufacturers must make available a minimum oof 20% of their real time pandemic production to WHO, half of that as a donation and the other half at “affordable prices.”

A second paragraph in the proposed KEI text would stipulate that the obligations set forth under the PABS Annex apply “exclusively” to products produced to address the public health emergency and “not extend to other uses or indications of the same products,” Love said.

Africa aims to level the playing field

Malawi’s Health Minister Madalitso Baloyi at the UN High Level meeting on HIV/AIDS in June.

It remains to be seen how African nations will respond to the new ideas being tabled as it seeks to assert itself in the PABS negotiations and ensure that citizens of its 54 countries have better access to medicines, vaccines and diagnostics.

At the recent United Nations High-Level Meeting on HIV/AIDS, the African group negotiated as a bloc – bar a handful of countries – and insisted on the inclusion of several paragraphs to encourage wider access to medicines, including local production, technology transfer and reward for innovation. Several Latin American countries also supported this position.

Africa also insisted on a last-minute amendment to the political declaration on HIV, proposing the removal of the phrase “mutually-agreed terms” in relation to technology transfer in three paragraphs of the 15-page declaration. 

“The African group believes that keeping ‘on mutually agreed terms’ in the text, in connection to technology transfer, undermines the key objective to access medicines, vaccines, and medical products, and to boost research and development,” said Malawian Health Minister Madalitso Baloyi on behalf of the Africa Group.

While the political declaration passed, the European Union (EU), Switzerland, Canada and several other countries dissociated themselves from these paragraphs.

Switzerland said that technology transfer should “always be on mutually agreed terms”.

It also objected to a paragraph (85) that committed countries to improving the transparency of markets for HIV-related health technologies, by “publicising production costs and prices of HIV-related products, through global, regional and national mechanisms, thus providing consistent and transparent information for fair price negotiations”.

“There are limits anchored in relevant international law to publicising information, such as production cost. Paragraph 85 raises concern regarding the protection of trade secrets, and more fundamentally, what role of state authorities can be in relation to private sector actors,” said Switzerland.

‘No country alone can fight’

Meanwhile, Tedros and other WHO officials have urged member states to hasten agreement of the PABS system, particularly in light of the recent string of dangerous disease outbreaks, including the Ebola Bundibugyo virus public health emergency declaration.  

“The outbreaks of hantavirus, Ebola and Marburg all show why there is no alternative to international cooperation in the face of international threats. No country alone can fight,” Tedros told a media briefing last week.

The outbreaks are that the risk of another pandemic erupting is “not some distant, hypothetical scenario in a briefing document,” Tedros added in his statement on Monday.

WHO’s head of health emergencies, Dr Chikwe Ihekweazu, said that navigating several public health emergencies simultaneously was a trend which is likely to continue.

“The threats are not going away,” said Ihekweazu. “But hopefully we can get stronger collectively to respond to these.”

Several positive developments had evolved out of the recent threats, he added. These included countries improving their disease response detection and response capabilities,  R & D on new countermeasures, and opportunities for countries to work together under the International Health Regulations, the legally binding rules for country conduct during disease outbreaks.

But, stressed Ihekweazu, the PABS system “absolutely has to be completed” to enable the Pandemic Agreement to be ratified and brought into effect to establish a strong global framework to address disease outbreaks.  See related story: 

https://healthpolicy-watch.news/drc-ebola-outbreak-may-be-much-larger-than-currently-reported/

Image Credits: PABS IGWG7 Debriefing.