Cruise Ship Hit by ‘Uncommon’ Human-to-Human Transmission of Hantavirus 05/05/2026 Kerry Cullinan The cruise ship Hondius, currently affected by a hantavirus outbreak. The cruise ship Hondius, at the centre of a hantavirus outbreak, is likely to dock in the Canary Islands where Spanish authorities will assess passengers, disinfect the ship and conduct a full epidemiological investigation. This is according to Maria van Kerkhove, director of the World Health Organization’s (WHO) Department of Epidemic and Pandemic Preparedness and Prevention, at a media briefing in Geneva on Tuesday. Meanwhile, arrangements are being made for two crew members with symptoms of the potentially fatal virus to be medically evacuated to the Netherlands, along with a third person travelling with the passenger who died onboard on 2 May. The crew members have “acute respiratory symptoms, one mild and one severe”, according to cruise operator Oceanwide Expeditions. All 149 people on board have been asked to remain in the cabins as a precaution. The WHO has deemed the global threat posed by the outbreak to be “low”, based on how the virus spreads. Seven passengers are suspected of having contracted the virus although laboratory tests have only confirmed it in two of the cases. Three passengers have died. A passenger was medically evacuated to South Africa where he is in intensive care. and two others are ill on board. The seventh originally had a fever but now appears asymptomatic, said Van Kerkhove. “Illness onset occurred between 6 and 28 April 2026 and was characterised by fever, gastrointestinal symptoms, rapid progression to pneumonia, acute respiratory distress syndrome and shock.,” according to the WHO. There is no specific treatment, and a high case fatality rate of up to 50% for the hantavirus found in the Americas, but “early supportive medical care is key to improving survival”, according to the WHO. Human-to-human transmission is ‘uncommon’ People usually contract hantaviruses from exposure to the urine, droppings or saliva of infected rats. Human-to-human transmission is “uncommon”, but it has been documented in Argentina involving the Andes virus, a species of the hantavirus, according to Van Kerkhove. The virus spreads between humans in “very close physical contact”, said Van Kerkhove. “When you have an enclosed settings, you have people that are spending a lot of time together. These types of things can happen,” she added. The Andes virus is found in Argentina, where the cruise ship began its voyage. It is thus possible that the index passenger was infected before he embarked, rather than on the ship. The first passenger to die was a 70-year-old male passenger “who suddenly became ill in the ship en route from Ushuaia to St Helena Island, and presented with fever, headache, abdominal pain, and diarrhoea”, according to the South African Department of Health. He died on arrival at St Helena. His 69-year-old wife flew to South Africa from St Helena, but collapsed at Johannesburg airport and later died at a nearby health facility. “The initial case and his wife joined the boat in Argentina, and with the timing of the incubation period of hantavirus, which can be anywhere from one to six weeks, our assumption is that they were infected off the ship,” said Van Kerkhove. The third patient, a British national, became ill while the ship was travelling from St Helena to Ascension, and was flown to a private health facility in South Africa. He has been confirmed with hantavirus and is in a “critical condition in isolation”. Hantavirus infection was confirmed in two of the patients by South Africa’s National Institute for Communicable Diseases (NiCD). Further tests, including sequencing of the virus, is being conducted by NiCD, as well as well as testing the two symptomatic patients on board with the support from Institut Pasteur of Dakar in Senegal. Van Kerkhove described the collaboration with member states as “excellent”. The WHO was informed of “a cluster of severe acute respiratory illness” aboard the ship by the UK on 2 May, in terms of the International Health Regulations. The timeline issued by Oceanwide Expeditions is as follows: On 11 April, a passenger died on board. The cause of death could not be determined. On 24 April, his body was disembarked on St Helena, with his wife accompanying the repatriation. On 27 April, Oceanwide Expeditions was informed that the wife had become unwell during the return journey and had later died. Both passengers were Dutch nationals. On 4 May, a variant of hantavirus was confirmed in the woman. On 27 April, another passenger became seriously ill and was medically evacuated to South Africa. This person is currently being treated in the intensive care unit in Johannesburg and is in a critical but stable condition. This passenger is of British nationality. A variant of hantavirus has been identified in this patient. On 2 May, another passenger on board died. The cause has not yet been established. This passenger was of German nationality. Image Credits: Oceanwide Expeditions. Investing in Midwives is Essential to Improve Sexual and Reproductive Health 05/05/2026 Teguest Guerma A midwife examines a pregnant woman. The International Day of the Midwife (May 5) reminds us that safe birth is not a stand-alone event, but part of the broader continuum of sexual and reproductive health and rights Most maternal deaths occur during labour, birth, or shortly after birth. Nearly 290,000 women died during and following pregnancy and childbirth in 2020, with 95% of these deaths occurring in low- and lower-middle-income countries. The major causes included severe bleeding, hypertensive disorders, infections, complications from unsafe abortion, and obstructed labour. Yet these events are largely preventable or treatable when skilled care, referral, medicines, blood, and emergency obstetric services are available. Midwives are often the first – and sometimes only – skilled provider able to detect and respond to such complications in a timely manner. But the world currently faces a shortage of up to a million midwives – part of a larger global health workforce crisis – that is concentrated in the countries and communities where maternal and newborn mortality is highest. Although skilled birth attendance globally is around 80%, this figure hides severe inequities within and between countries. Women in rural areas, poor households, conflict settings, humanitarian crises, and marginalized communities are least likely to have access to a skilled midwife or other qualified birth attendant. Access is not only about whether a health care facility exists, but also depends on distance, transport, user fees, staffing, respectful care, medicines, referral systems, and whether women trust the system enough to use it. Safe birth and post-natal care are not standalone events. They are part of the broader continuum of sexual and reproductive health and rights that includes health education, contraception, antenatal care, screening of sexually transmitted infections, safe birth, emergency response, postnatal and newborn care, breastfeeding support, and referral, as well as safe abortion and post-abortion care. High maternal mortality ratio The current global maternal mortality ratio of 223 deaths per 100,000 live births is well above the Sustainable Development Goal target of achieving less than 70 deaths per 100,000 live births by 2030. Midwives can provide around 90% of essential SRHR care when they are educated, licensed, regulated, and supported to international standards. But in many low-resource settings, midwives are too few, poorly distributed, underpaid, ill-equipped, or not fully authorized to practice to their competencies. Scale-up to achieve universal coverage of midwife-delivered interventions is one of the clearest and most practical routes to faster progress and to averting a larger share of maternal and neonatal deaths and stillbirths. Investment in the workforce must include education, fair pay, regulation, safe working conditions and career pathways, supplies, data systems, and integration into primary health care. Policy settings need to remove financial barriers to care and treat SRHR as a complete package, rather than as a range of isolated services. Countries are demonstrating increasing innovation in the midwifery field. In Sierra Leone, for example, structured preceptorship (mentorship) programmes are strengthening hands-on clinical skills and confidence among midwives, helping translate training into safer care at the bedside. In Ethiopia, a center of excellence in midwifery trains disadvantaged rural girls to become ethical and compassionate midwives in their own communities. Efforts such as these are key to empowering midwives and the women and children they serve before, during and beyond childbirth. Midwives already save lives every day. The task now is to ensure that they can do so for women everywhere. Dr Teguest Guerma is the founder and CEO of LeDeG Midwifery College, established in 2015 to address critical gaps in maternal health across Ethiopia and beyond. Image Credits: Elizabeth Poll/MMV, Twitter: @WHOAFRO. Pandemic Talks Extended – But Colombia Appeals for New ‘Method’ to Settle Differences 04/05/2026 Kerry Cullinan South Africa, speaking for the Africa Group and Group for Equity. Colombia has appealed for a new “method” to settle the outstanding annex of the Pandemic Agreement, after World Health Organization (WHO) member states failed to reach agreement last week after almost a year of talks. Talks on a Pathogen Access and Benefit Sharing (PABS) system were due to wrap up last Friday night, but have since been extended to July, with a resolution in that regard being prepared for the World Health Assembly, which starts on 18 May. “There is one fundamental point that we request be included in the resolution: extending the negotiating period makes no sense unless the negotiating method is changed,” Colombian Ambassador Germán Velásquez told the Intergovernmental Working Group (IGWG) shortly before the meeting closed last Friday evening. “It is not possible to continue seeking consensus in the same way. Why not introduce the concept of ‘progressive consensus’? Once a majority has been reached on specific points, a vote should be held if necessary, and negotiations should continue.” Colombia is part of the Group for Equity, a large cross-regional alliance of countries that has been pushing for a PABS annex that ensures the inequity of the COVID-19 pandemic, where wealthy countries commandeered all the scarce vaccines, is not repeated. The proposal for voting also has the support of some civil society groups, notably Pedro Villardi, from Public Services International, a trade union federation with over 30 million members. “If we need [to reach an agreement], why don’t we vote? We have a majority of countries pushing for equitable provisions… and we have a few countries that are opposing these measures and defending the position of the pharmaceutical industry and other big corporations,” Villardi told a recent briefing on the negotiations. Increasingly frustrated The Group for Equity and the Africa Group – which represent the vast majority of member states – have become increasingly frustrated by what they see as developed countries protecting the interests of their pharmaceutical companies instead of levelling the playing field ahead of future pandemics. The PABS system is due to govern how dangerous pathogens are shared during public health emergencies and how any medical products (benefits) that accrue from this information are shared. The dispute, mainly between developed and developing countries, hinges on how countries that share pathogen information can benefit from any vaccines, therapeutics or diagnostics (VTD) developed as a result. The Group for Equity and Africa want mandatory benefit-sharing, with the terms set out in standard contracts between the WHO and pharmaceutical companies. Several European countries – notably those with powerful pharmaceutical industries – argue that compulsory benefit-sharing will stifle research and development. According to the current draft, the WHO will receive a donation of 10% of vaccines or medicines produced by pharmaceutical companies that sign up to PABS – but only during a pandemic, not a public health emergency of international concern (PHEIC). ‘Deep regret’ At the close of last week’s talks, South Africa – unusually speaking both for Africa and the Group for Equity – expressed “deep regret” that IGWG is “still far from reaching consensus on the text of the Pandemic Agreement annex”. “We have engaged constructively and in good faith, including by putting forward concrete proposals. We also considered other approaches, but found, ultimately, that these fall short of the IGWG mandate to deliver a PABS annex that preserves the principle of an equal footing between access and benefit sharing,” said South Africa. “Approaches that risk decoupling these elements, or introducing fragmentation from the outset, are not sustainable foundations for the system we are tasked to build, and may only legitimise the unfair status quo regarding access to essential health products,” added South Africa, referring to a “hybrid” proposal put forward by some European countries during informal negotiations. The two groups are “strongly united” on a PABS system that is “fair, equitable and capable of correcting long-standing imbalances, including inequitable access to VTDs and unjust extraction of our genetic resources”, said South Africa. “A credible landing zone requires legal certainty at a point of access on how benefit-sharing obligations will be operationalised and enforced. This is neither excessive nor unreasonable. It is fundamental to trust in the system.” Convergence Nepal, speaking for Southeast Asia, warns against weakening the link between access and benefit-sharing. Nepal, speaking for WHO’s South East Asia region, stressed “the importance of ensuring that the PABS system preserves the intrinsic linkage between access and benefit-sharing. “Approaches that risk weakening this relationship or introducing fragmentation from the outset would not provide a sustainable or equitable foundation for the system we are mandated to establish,” Nepal cautioned, apparently also in reference to the “hybrid” option. Meanwhile, another diverse group represented by the Dominican Republic, but including Australia, the Bahamas, Barbados, Malaysia, Mexico, Norway and Singapore, offered to be a bridge to find “convergence” for a “sufficiently clear, credible and operationally effective” PABS system. Meanwhile, the EU also expressed regret at the failure to reach agreement, expressing its full commitment to “finalise and agree on a PABS system that will make a real difference and truly change things on the ground”. The European Union regrets that IGWG was unable to reach agreement on PABS. ‘Disservice to humanity’ The next IGWG will be from 6 to 17 July, and the new aim is for a PABS annex to be ready for next year’s World Health Assembly. Closing Friday evening’s session WHO Director General Dr Tedros Adhanom Ghebreyesus acknowledged that the talks have been “a roller coaster”. “Real progress was made on the PABS annex, but important differences remain. Please stay engaged. We need everyone. My one piece of advice is this: please approach the outstanding issues with a sense of urgency, because the next pandemic is a matter of when, not if,” said Tedros. Echoing this warning, Helen Clark and Ellen Johnson Sirleaf, co-chairs of The Independent Panel for Pandemic Preparedness and Response, said that “a lack of action to prevent and prepare for the next pandemic threat is a disservice to humanity”. They called on governments to do more on pandemic prevention, preparedness, and response (PPPR): “All countries must be able to detect and rapidly report outbreaks which may pose an international threat.” However, they also acknowledged that many low- and middle-income countries are impacted by high debt levels, and a sharp decline in development assistance. “Leaders have an opportunity to demonstrate their commitment to protect humanity at the upcoming UN High-Level Meeting on PPPR in New York in September. “There, they must make progress to fill enduring gaps in PPPR including on co-ordination, financing, equity, and accountability. They should also make it clear that the PABS Annex must be finalised to enable the WHO Pandemic Agreement to proceed.” Methane Emissions From Fossil Fuels Near Record Highs 04/05/2026 Stefan Anderson An infrared camera reveals escaped methane emissions from oil rig. Methane leaks from oil and gas make a major contribution to global warming. Methane emissions from fossil fuels stayed near record highs in 2025, with no sign of decline despite proven, low-cost ways to reduce them, the International Energy Agency (IEA) said on Monday. “Methane emissions from the energy sector plateaued near record highs,” the IEA found in its annual Global Methane Tracker. “There is still no sign that methane emissions from fossil fuel operations are falling, despite well-known and proven mitigation pathways.” The findings land halfway towards the 2030 deadline for cutting global methane emissions by 30%, a target that 159 countries and the European Union (EU) set under the Global Methane Pledge. A UN assessment released at COP30 found nations were on course to deliver less than a third of that. Methane is responsible for nearly 30% of the rise in global average temperatures since the Industrial Revolution. With an atmospheric lifespan of around 12 years, against centuries for carbon dioxide, cutting it is one of the fastest available levers on near-term warming, often described as the climate “hand brake”. More than half of global oil and gas output is now covered by company pledges to near-zero methane emissions, up from less than 20% in 2021. But the report found a “large implementation gap” between commitments and outcomes. “Countries and companies have raised their ambitions on methane, moving the issue higher up the policy agenda,” said Tim Gould, the IEA’s chief energy economist, who presented the findings at a high-level event in Paris convened by France’s G7 presidency. “However, setting reduction targets is only a first step, and it is important to ensure they are backed up by policies, implementation plans and real actions.” Fossil fuel production drives methane Oil, gas and coal production reached record levels in 2025, the IEA found. While the report found the global average upstream methane intensity of oil and gas production has fallen by around 10% since 2019, the IEA estimates total methane emissions from fossil fuel activities remain at 124 million tonnes a year, equivalent to the annual emissions of around three billion cars. Methane is the main component of natural gas and is emitted across the fossil fuel supply chain: vented from equipment by design, flared incompletely, leaked from valves, pipelines and storage tanks, or released from coal mine ventilation shafts, inextricably tying methane emissions levels to oil, gas and coal production. Oil is its largest source, releasing the equivalent of around two-thirds of the EU’s annual gas imports. Coal follows closely, then natural gas, the report found. A further 20 million tonnes comes from the incomplete burning of wood, charcoal and other traditional fuels in developing economies, principally used for cooking. Around 70% of methane emissions from fossil fuel operations could be cut using existing technology, the IEA said, with more than 35 million tonnes avoidable at no net cost as the price of gas offsets the investment needed to capture it. “This is not only a climate issue,” Gould said. “There are also major energy security benefits that can come from tackling methane and flaring, especially at a time when the world is urgently looking for additional supply amid the current crisis.” European Union energy chief Dan Jorgensen, speaking at the G7, added that capturing the gas being lost would significantly ease pressure on global markets. “We could have three times more gas on the market if we eliminated this waste,” Jorgensen said. “This shows that methane abatement and energy security are not competing priorities.” “Methane is the single fastest lever we have to limit near-term warming. We can no longer wait to pull this lever.” Pledges expand, emissions don’t The push for methane action accelerated at COP26 in Glasgow in 2021, where the United States, the EU and more than 100 other countries launched the Global Methane Pledge. The pact now covers 159 countries and nearly three-quarters of global oil and gas production. Five years on, COP26 president Alok Sharma, who guided the methane pledge across the line, said action is not living up to the scale required to abate the climate crisis. “Things are looking much bleaker than they were,” Sharma told a high-level meeting at IEA headquarters on Friday. “We breached 1.5°C last year and the year before, temporarily, and frankly, the prognosis is not good.” With no decline in fossil fuel emissions globally in 2025, atmospheric methane concentrations continued to rise. The IEA estimates that more than 85 million tonnes of fossil-fuel methane in 2025 came from the 10 biggest emitters: China, US, Russia, Iran, Turkmenistan, India, Venezuela, Indonesia, Kazakhstan and Iraq. Together, they account for around 70% of global fossil fuel methane emissions. The methane intensity of oil and gas production, or emissions per unit of energy delivered, varies widely, with the best performers scoring more than 100 times better than the worst, according to IEA data. Norway has the lowest upstream intensity in the world, the IEA found, achieved through a national ban on non-emergency flaring and a tax on venting and flaring introduced in 2015. Producers in the Middle East, including Saudi Arabia and the United Arab Emirates, also perform relatively well, according to the report. Turkmenistan and Venezuela have by far the highest intensities, the result of ageing Soviet-era and decrepit state-run infrastructure operating with little regulatory oversight. Independent analysis from the Stop Methane Project at UCLA found Turkmenistan dominated the list of the 25 worst-emitting facilities globally in 2025, emitting a “mind-boggling” amount of methane experts say could be easily contained. If every country matched Norway’s methane emissions intensity, global oil and gas methane emissions would fall by more than 90%, the IEA found. “Action on methane is not a fight of any single actor and nobody can win it alone,” French environment minister Monique Barbut said at the Paris event. “We must be clear: the energy sector offers today the fastest and often the most cost-effective reductions.” COP presidents press for action The IEA report was previewed at a high-level event at the agency’s Paris headquarters last week, where the COP31 presidency, made up of Turkey and Australia, set out priorities for the November summit in Antalya. Laurent Fabius, the former French prime minister who shepherded the Paris Agreement at COP21, said methane should be a central focus in Turkey, where the UN Environment Programme is expected to release its annual Eye on Methane report. Last year’s edition, launched at COP30 in Belém, found current national commitments would cut global methane emissions by just 8% below 2020 levels by 2030, under a quarter of the pledge target. “Methane is the faster way of trying to diminish global warming,” Fabius said. “Progress has been made. Pledges do exist, efficient techniques too, but we know that it is not enough. Methane should be one of the stars of COP31.” Sharma also pressed the point on finance, which he said was still falling far short of what was needed. Global clean energy investment reached a record €2.3 trillion last year, but a third of what was needed by 2030. Only 10% had gone to hard-to-abate sectors, and more than 80% to East Asia, Europe and the United States. Excluding China, developing countries representing 30 to 35% of global emissions were not getting the finance they need, he said. “We’re still nowhere near the scale that we should be … If you want to transition away from fossil fuels, you need to provide the finance for people to do that,” Sharma said. “We need to make sure there’s grant support to help developing nations look at their regulatory regimes.” “There will be some people who will say, and they’ve said it in the past, that the COPs are not the place this nitty gritty discussion on finance. That’s wrong. That is totally wrong,” Sharma said. “It is absolutely the place where we ought to be having discussion about these details on finance.” Simon Stiell, the UN Climate Change Executive Secretary, framed the energy crisis triggered by the war in the Middle East as an argument for accelerating the transition itself, which would in turn cut methane at source by reducing demand for the fossil fuels that produce it. “Those who’ve fought to keep the world hooked on fossil fuels are inadvertently supercharging the global renewables boom,” Stiell said. “This latest fossil fuel cost crisis has made the economic logic of renewables impossible to ignore.” “Renewables offer safer, cheaper, cleaner energy that can’t be held captive by narrow shipping straits, or global conflicts,” Stiell said, adding that “slashing methane” should be one of the most urgent priorities of COP31 for its potential to deliver “fast climate benefits while saving money.” Clean cooking and the bioenergy gap Around 18 million tonnes of methane emissions in 2025 came from the roughly 2 billion people worldwide who cook on open fires or simple stoves burning wood, charcoal and agricultural residues, with serious consequences for human health and the environment. Nearly half of them live in sub-Saharan Africa, where four in five households have no access to clean cooking technology, according to data released at the IMF Spring Meetings. The smoke produced exposes mostly women and children to particulate matter and carbon monoxide, driving severe respiratory and cardiovascular disease. Cooking with solid fuels is linked to 815,000 premature deaths a year globally, and household air pollution from these fuels remains one of the leading environmental health risks worldwide. “Expanding access to clean cooking solutions, including liquefied petroleum gas, electricity, improved biomass stoves and clean biofuels, offers further scope to cut methane emissions while delivering substantial health, gender and economic benefits in communities most affected by traditional biomass use,” the report said. Clean cooking is one of the COP31 presidency’s stated priorities, alongside electrification, zero waste and finance, representatives of the presidency from Turkey and Australia said. “Electrification, clean cooking, zero waste and finance, these are things that we can all gather around,” said Australia’s ambassador Stephen Jones, deputising for the country’s COP31 negotiations president. Jones said the climate transition and the response to the energy crisis were the same fight. “The clean energy solution is the solution to the energy crisis that we are now engaged in,” he said. “Paris is working. But we have to work faster and put more effort in.” Image Credits: Clean Air Task Force , IEA, IEA . Big Tobacco is No Longer Selling Cigarettes – It Is Engineering Addiction 04/05/2026 Hans Henri P. Kluge The tobacco industry is using sophisticated marketing aimed at young people. Europe needs a more precise focus to address the tobacco industry’s “engineered architecture of addiction”, featuring flavoured tobacco and nicotine products with ever more sleek designs. As an early champion of global tobacco legislation, the region can reposition itself to lead again – including through updated European Union directives on tobacco product regulation, advertising and taxation. Twenty-one years ago, the WHO Framework Convention on Tobacco Control (FCTC), the world’s first global health treaty and one of the EU’s earliest major public-health commitments, entered into force. It has helped to drive a reduction in tobacco use, with over 120 million fewer people using tobacco worldwide and best-practice protections expanded to more than six billion people. As a new WHO/ Europe report, published last year to mark the treaty’s 20th anniversary, shows, its core principles remain relevant – perhaps even more so today, as new products and tobacco industry tactics disrupt public health progress in unprecedented ways. Tobacco remains one of the world’s most lethal health hazards, killing more than seven million people globally each year, including an estimated 1.6 million non-smokers who are exposed to second-hand smoke. The WHO’s European Region, with 53 member states, has the dubious distinction of being the world’s leader in tobacco use, as well as the global leader in growing e-cigarette use among youth. Tobacco use trends (2000-2030) The scale is stark: in 2024 alone, 173 million adults and four million adolescents aged 13-15 were tobacco users, alongside 31.4 million adults and 4.2 million adolescents using e-cigarettes. What is increasingly evident today is that the danger is no longer confined to tobacco itself. It has shifted toward the engineered architecture of addiction – products designed to attract new consumers, sustain dependence and undermine public health. Flavours, filters, and sleek designs for Gen Z and younger The tobacco industry is much more than harvesting, curing, or rolling leaves. It now has sophisticated products and advertising machinery built to capture attention, personalise user experience, stay one step ahead of regulation and hook consumers long before they ever touch a cigarette. The tobacco and nicotine industry now markets an expanding universe of products – from heated tobacco and e-cigarettes to “aromatic nose inhalers” and nicotine pouches. Most of these products contain nicotine in different forms and concentrations, flavours and all of them exploit desire, reward pathways and the psychological hooks of habit and dependence. If, in the last century, cigarettes were marketed by images of rugged masculinity and reassuring doctors, today’s new generation of tobacco and nicotine products is packaged in joyful, playful social media posts attuned to millennials, Gen Z and younger audiences. There is bright packaging, unboxing videos, or lifestyle clips that blur the line between advertising and entertainment. Many play along, click, like and share. New products are being designed to attract children and young adolescents, mimicking candies and toys. The strategy remains the same: to make nicotine and tobacco products look modern, harmless, and desirable. Much of this content is not presented as advertising at all. The addictive architecture of social media does the heavy lifting. Influencers trusted by millions of young followers may feature these products under the guise of authentic personal recommendations, while in reality contributing to the industry’s transnational marketing reach. Viral ads multiplied by trust is a very powerful combination that does much harm in the wrong hands. This concerns me personally. As a father of two daughters, I can see how important social media is for them. It gives the feeling of emotional connection, belonging, and significance. And this is true for me as well – I can feel social media influencing my worldview and my work at WHO/ Europe every day. Full implementation of Framework Convention on Tobacco Control One of the most striking findings in the WHO/ Europe report is that the most powerful tobacco-control measures are already known and proven to work, but their adoption and proper implementation at country-level is lacking. Since 2019, rates of adolescent e-cigarette use have increased in 22 of 25 EU countries reviewed, and in all of them, girls report higher use than boys. Tobacco use among women in the EU remains high and sharply contrasts with the global downward trend. This is in line with the findings of the European Commission’s latest evaluation of the EU tobacco control framework, which highlights the rapid rise of novel tobacco and nicotine products — especially among young people — as a key and growing challenge. All of this points to one conclusion: full implementation of the WHO FCTC is overdue. The EU’s existing directives – the Tobacco Products Directive, the Tobacco Advertising Directive, and the Tobacco Taxation Directive – must be updated and strengthened to deliver on the treaty’s commitments . Today’s major problems include uneven implementation, regulatory loopholes, and slow adaptation to new products and new realities of digital marketing –all influenced by the tobacco industry. A strong political commitment is necessary to overcome these challenges and change the trajectory of nicotine and tobacco use. Europe can lead once again By accelerating implementation, closing regulatory loopholes, modernizing legislative frameworks to address digital marketing, and applying effective price and tax measures, the EU can set a powerful global example and advance the vision of a Tobacco-Free Generation by 2040, an ambition set out in Europe’s Beating Cancer Plan, and later re-iterated in the EU Safe Hearts Plan. Twenty years on, the FCTC continues to provide a strong foundation, but today’s market realities call for its full implementation that is complemented by forward-looking measures. As an early architect and champion of the FCTC, the EU is uniquely positioned to lead once again – and this leadership will be most effective if exercised without delay, ensuring that policy not only keeps pace with, but anticipates, emerging products and industry tactics. Hans Henri Kluge is the regional director of the WHO/European Region. Image Credits: Filter, WHO, WHO. Landmark EU Vote Demands ‘Only Yes Means Yes’ Rape Law, Targeting Gaps in Survivor Care 01/05/2026 Felix Sassmannshausen Legislators Joanna Scheuring-Wielgus and Evin Incir present the parliament’s demand for a rape law based on an ‘only yes means yes’ principle. STRASBOURG – Amid a global backlash against sexual and reproductive rights, the European Parliament has taken a decisive stand by voting for a unified, human rights-based standard for sexual offences. This Europe-wide legislative push aims to overhaul the fragmented national laws that currently leave many survivors without access to justice or essential health support. The resolution formally urges the European Commission to draft binding laws that recognise rape is fundamentally defined by a lack of consent. This represents a stark departure from outdated national models that require victims to physically fight back or explicitly say no. Swedish lawmaker Evin Incir addresses the European Parliament. “It is both morally and legally unacceptable that women are not protected by ‘only yes means yes’ legislation across the EU,” leading lawmaker Evin Incir from the centre-left social democrats (S&D) declared following the plenary vote on Tuesday. Just hours earlier, the European Parliament had adopted a landmark report with 447 votes in favour, 160 votes against, and 43 abstentions, demanding a unified standard for sexual offences. The push for reform is driven by a societal reckoning, spurred by cases that have sparked international outrage, such as that of Gisèle Pelicot in France. During a high-profile 2024 trial, the public learned that Pelicot’s husband had covertly drugged and raped her over a decade, also inviting dozens of men to rape her while she was unconscious. Human rights baseline: only yes means yes Comparison between outdated force-based legal requirements and the Parliament’s proposed standard of affirmative, voluntary consent. At the core of the European debate is the push for an ‘only yes means yes’ principle to ensure that any sexual act without freely given consent is legally classified as a crime. While a clear verbal “yes” is the most direct method, legal experts emphasise that consent can be expressed in any voluntary and unambiguous way, meaning affirmative gestures or reciprocal actions, depending on the specific context of the relationship. Establishing legislation focused on the lack of consent is widely viewed as the necessary next step to implement the Istanbul Convention. Opened for signature in 2011 and ratified or acceded to by 39 parties, Article 36 of this comprehensive international treaty explicitly requires member states to criminalise all non-consensual sexual acts, setting a clear human rights baseline. A unified legal definition is essential for health policy, as it directly impacts how survivors access emergency contraception, trauma counselling, and forensic medical care. Recognising the health sector’s critical role in this recovery process, the WHO Regional Office for Europe provides health system baseline assessments to help stakeholders monitor member states’ compliance with the Istanbul Convention. The latest comprehensive EU gender-based violence survey reveals that a staggering 30.7% of women across the bloc have experienced physical or sexual violence, which aligns with global data. Crucially, 8.4% of women report being raped while under coercion or being unable to refuse, nearly double the 4.8% who experienced overt physical force. Despite this high prevalence, systemic barriers continue to suppress official reporting and hinder access to post-rape care. Only 13.9% of victims ever contact the police, frequently citing embarrassment, fear of retaliation, or a belief that law enforcement cannot help them as their primary reasons for silence. Acknowledging trauma and fear responses Neurobiological evidence from the Karolinska Institute shows 70% of survivors experience paralysis, supporting calls for an ‘only yes means yes’ approach. A critical aspect of focusing on the lack of consent involves officially recognising the physiological realities of trauma. Medical experts and victim advocates continuously stress that a lack of physical resistance does not equate to a voluntary agreement. Co-rapporteur Joanna Scheuring-Wielgus during the plenary debate. Legislators underscored the neurobiological “freeze” response, where a victim perceives overwhelming danger, and the body is rendered completely paralysed. “It’s important to understand that a victim may not always have the strength to fight, to say no,” Polish co-rapporteur Joanna Scheuring-Wielgus explained at the press conference. While some victims might actively fight back, others can also freeze or faint. A 2017 Swedish study from the Karolinska Institute found that 70% of sexual assault survivors experience significant “tonic immobility,” an involuntary, temporary state of motor inhibition triggered by intense fear. Current legal systems in several member states routinely dismiss cases where victims experienced this involuntary physiological paralysis, which the European Parliament notes causes severe secondary victimisation. Furthermore, victim support networks like Women Against Violence in Europe (WAVE) warn that failing to provide trauma-informed, gender-specific responses deters survivors from seeking essential medical and psychological support. Implementing laws based on an ‘only yes means yes’ principle would mandate that judges and law enforcement officials understand these complex trauma responses. Policy analysts argue this shift is vital for building trust in public institutions and ensuring that victims feel safe enough to access specialised healthcare services. Fractured legal landscape leaves survivors vulnerable German legal barriers create a stark gap between rising rape reports and actual criminal convictions. The contrast between different national models highlights why European lawmakers are demanding unified rules. In Germany, the current framework dictates that a victim must signal refusal, meaning perpetrators often escape conviction if the victim remains passive due to fear. According to recently published data from the Federal Criminal Police, 14,454 rapes were reported in Germany in 2025, an 8.5% increase that officials attribute primarily to a growing willingness among victims to come forward. However, the consequences of the current legal framework are still reflected in extremely low conviction rates, with the women’s rights organisation Terre des Femmes estimating that only one in one hundred rapes ultimately results in a conviction. Legal practitioners, including the German Women Lawyers Association, argue that this standard protects perpetrators rather than victims by shifting the responsibility of communication onto the assaulted person. They maintain that establishing the lack of consent as the legal threshold is the necessary next step to enable more victims to seek justice. Conversely, countries such as Sweden and Spain have recently reformed their penal codes to ensure that sexual relations must be affirmatively agreed upon. While Sweden has already recorded a subsequent rise in convictions due to broadened evidence admissibility, monitors note that Spain’s groundbreaking 2022 law has yet to translate into similar statistical increases. Political tide is changing in Europe After tough negotiations, the European Parliament voted for a unified legal standard based on an ‘only yes means yes’ principle on Tuesday. The road to a unified standard has been fraught with conflict. During the 2024 negotiations for the EU’s first Directive on violence against women, a blocking minority led by France, Germany, and Hungary successfully stripped rape from the final text. Rapporteur Evin Incir reminded the public of the “unholy alliance” of leaders – including Viktor Orbán and Emmanuel Macron – who formed this blocking minority. These national leaders had argued that the European Union lacked the legal competence to harmonise criminal laws on sexual violence. Only US Votes Against Women’s Rights Document at UN Commission However, the political winds are shifting. Mounting public pressure has forced national governments to reconsider, with countries like France now actively revising their own criminal codes to align with an ‘only yes means yes’-based model. Despite the momentum, the proposal faces fierce opposition from far-right factions who frame the initiative as an ideological overreach. During the Strasbourg debate, an MEP from the Patriots for Europe group argued that “human relationships do not unfold through formalized steps or legal checklists,” claiming the law would amount to morally policing intimate desire. Other right-wing voices attempted to pivot the debate toward anti-immigrant narratives, suggesting lawmakers should “protect the streets, not the bedrooms”. Progressive lawmakers swiftly rejected this framing, citing data that proves the vast majority of sexual assaults are committed by perpetrators known to the victim, underscoring the systemic, domestic nature of the crisis. More than judicial reform needed The proposed European standard combines legal reform with mandatory education and trauma-informed training for law enforcement. Establishing the ‘only yes means yes’ principle as the legal threshold for rape demands a fundamental re-evaluation of how European societies view sexual availability and interpersonal power dynamics. The core premise is that sexual partners must actively communicate their desires and mutually negotiate the boundaries of their intimacy. However, reforming the penal code to reflect the lack of consent is only one part of the broader societal transformation envisioned by the European Parliament. Lawmakers are heavily emphasising the need for mandatory, comprehensive sexuality and relationship education across all member states. To ensure these legal reforms are effectively applied, parliamentarians are also demanding mandatory, trauma-sensitive education for law enforcement officers to prevent secondary victimisation during police investigations. “Why in 2026 should it be controversial that we demand that it should be mandatory for those who are working to support these women and girls who are victims?” rapporteur Incir asked, pointing to the tough negotiations with conservative co-legislators. The European Commission has signalled its readiness to support this cultural shift by mapping the current legal landscape across the Union to identify further legislative action. However, it could take years before an EU-wide law takes effect: after the Commission proposes a legal framework, the parliament and EU member states have to negotiate their positions and find a compromise. Image Credits: Felix Sassmannshausen/HPW. Energy Transition ‘Past Point of No Return,’ 57 Nations Declare at First Fossil Fuel Phase-Out Summit 01/05/2026 Stefan Anderson Coalition launches first sustained diplomatic push to phase out oil, gas and coal as war in the Middle East exposes the costs of fossil fuel dependence. The first international conference on phasing out the oil, gas and coal igniting the climate crisis ended with 57 governments representing every continent and a third of the global economy declaring the transition away from fossil fuels is now irreversible. “Actions taken to date prove that the energy transition is past its point of no return,” the coalition declared in its closing document, affirming all members were “ready to advance their transition away from fossil fuels.” The momentum is partly driven by concern for the planet, but also by a strategic desire for the energy independence that renewables could provide in an era of geopolitical instability – a case sharpened by the havoc the war in the Middle East was wreaking on the global economy as delegates gathered on Colombia’s Caribbean coast. “In a time that has been marked by fragmentation, that has been affected by war, by mistrust and the climate crisis, to sit here together and talk about the challenges, talk about the taboos, it’s a deep transformation of policy,” Irene Vélez Torres, Colombia’s environment minister and conference co-chair, said in her closing remarks in Santa Marta. Conference co-chairs Irene Vélez Torres, Colombia’s environment minister, and Stientje van Veldhoven, the Dutch climate minister, celebrate at the closing plenary. “When they look back at us from the future, they will remember that we were there, working on the challenges of our time,” Vélez Torres added. “That we decided not to focus on an economy built on war and destruction — we decided instead that it was necessary to prioritise life, security, certainty, sovereignty and solidarity.” The conference produced no binding commitments, no finance pledges, no promises of emissions cuts — that wasn’t the point. Instead, organisers pitched the summit as a “safe space” for countries already committed to phasing out fossil fuels to speak frankly. No negotiations, no consensus text to be watered down, no red lines passed down from governments to throw a wrench into discussions. A space free of the fossil fuel lobbyists who fill the corridors of UN climate summits by the thousands, both openly and embedded in petrostate delegations, often outnumbering full national delegation teams. “The fact we didn’t have negotiations here makes for such a different dynamic,” said Stientje van Veldhoven, the Dutch climate minister and co-chair alongside Vélez Torres. “The psychology of the Santa Marta process is something that we will definitely make sure to carry forward.” A coalition born of frustration Two weeks of negotiations in Belém, Brazil, failed to address a phase-out plan for coal, oil and gas as more than 100 nations blocked language on the fossil fuels at the root of the climate crisis. Three years on from the COP28 breakthrough in Dubai, where nearly 200 countries agreed to “transition away from fossil fuels,” efforts to translate the pledge into concrete action have hit a wall. Negotiations to agree a phase-out roadmap at COP30 in Brazil last November were torpedoed by a coalition of petrostates led by Saudi Arabia, which drew over half of the nations in attendance to its side in opposing the plan. The final text in Belém contained no reference to “fossil fuels” at all, a marked step backwards for the UN climate process. Without that failure, the Santa Marta conference would not exist. Conceived in the hours after COP30 collapsed, the new process was born of frustration with the gridlock of consensus-based UN climate diplomacy. But its architects stressed that it is meant to be complementary to mainstream COPs, not to replace them. “It’s very important that we agree on the fact that we want this conference, this process, to be like an accelerator for what we want to do in the context of UNFCCC,” van Veldhoven said, adding that the chairs have already been in touch with the COP31 presidency. Alongside government ministers, the conference included nearly 3,000 representatives of subnational governments, trade unions, scientists, civil society groups, Indigenous Peoples, women’s organisations and youth representatives, all named in the closing document as equal participants rather than observers, the title they hold in UN negotiations. “A new reality is taking shape: this is no longer a one-off moment, but the foundation of an ongoing international process dedicated to phasing out fossil fuels,” said Kumi Naidoo, president of the Fossil Fuel Treaty Initiative. “What is emerging is a process that can finally match climate diplomacy to the scale of the crisis.” Countries will attempt to carry the momentum forward at the next phase-out conference, confirmed in the closing hours to be held in 2027 on the Pacific island of Tuvalu and co-hosted by Ireland, pairing a wealthy European island with one across the globe at risk of disappearing under sea-level rise. “We are making history. We have proven, in the words of our youth, that another way is possible,” Tuvalu’s representative said. “The world is in a fossil fuel crisis, of climate breakdown, of conflict, of instability. But here in Santa Marta, we have planted a seed of solutions.” The tailwind from Hormuz Roughly a fifth of the world’s oil passes through the Strait of Hormuz, where wartime disruptions have driven prices to their highest level in years and exposed how much the global economy still depends on fossil fuels. Running through the conference was the war between Israel, the United States and Iran, which has disrupted shipping through the Strait of Hormuz, tightening gas supplies across Europe and Asia and skyrocketing oil prices to their highest level in years. On the same day delegates closed proceedings, US President Donald Trump told reporters Iran would have to “cry uncle” before he lifted what he called his “genius” blockade. Brent crude hit $126 a barrel hours later, approaching the spike that followed Russia’s invasion of Ukraine in 2022. For the three-quarters of the world that depends on fossil fuel imports, the message of the past five days was hard to miss: their energy costs, inflation rates, fiscal stability and the prices their citizens pay for food and fuel are tied to decisions made by a handful of leaders in Washington, Moscow and Riyadh – none of whom were in Santa Marta. The coalition’s closing document named the Hormuz crisis directly, calling the disruptions a demonstration “that reducing fossil fuel dependencies is critical” to “keep our planet livable, to safeguard energy security, and to build economic resilience to volatile fossil fuel markets.” “Destructive oil wars, widening fuel and food shocks, and a mounting climate crisis only bolster the conviction that breaking free from the fossil fuel system is not a matter of magical realism but of radical realism, in line with science and the law,” said Nikki Reisch, director of climate and energy at the Centre for International Environmental Law. Van Veldhoven framed the crisis as part of the case for moving faster. “If these countries significantly reduce their dependency on fossil fuels, it means they’ll be investing in their own economy instead of importing fossil fuels from abroad,” she told Bloomberg. “It means they’ll be investing in clean technologies, but it also means they’ll be shielding their economies against the kind of price shocks we’re seeing currently.” Santa Marta: Key outcomes from first summit on ‘transitioning away’ from fossil fuels | @daisydunnesci Read here: https://t.co/YGUgQR5BTg pic.twitter.com/1nZuILSPO7 — Carbon Brief (@CarbonBrief) May 1, 2026 France became the first major economy to act on that argument at scale during the conference, releasing a national roadmap to eliminate fossil fuels from its energy mix by 2050. The plan does not introduce new pledges but consolidates existing French climate and energy targets under a single explicit goal: ending the use of oil, gas and coal for energy purposes by 2050. Globally, the picture is mixed. Fossil fuels remain responsible for more than 75% of greenhouse gas emissions, but new renewable capacity in 2025 is nearly 50% higher than in 2023, and renewables are meeting nearly all new energy demand, according to the International Energy Agency. Investment in the energy transition reached a record $2.4 trillion in 2024, more than double 2019 levels, though it is concentrated in advanced economies and China, IRENA found. “This momentum is not yet enough to deliver the needed breakthrough,” said Bronwen Tucker, public finance lead at Oil Change International. “The richest polluting countries must take immediate action to accelerate their transitions at home and show up with meaningful international economic cooperation.” Coalition of the self-aware For all its ambition, the coalition openly admitted the limits of its own reach. The outcome document released in Santa Marta lays out in candid detail the shortcomings of the coalition in Colombia, and the distance all nations still have to go to achieve the transition away from fossil fuels. Chief among these admissions is the degree to which most nations in attendance continue to be dependent on oil, gas or coal for the public revenues that fund health, infrastructure and other government functions, and ensure energy security. Until governments find a way to replace that funding, walking away from fossil fuel production remains off the table. “The countries present in Santa Marta still have structural dependencies to overcome, including fiscal dependencies, debt constraints, the dependence of the financial architecture on fossil fuels,” the outcome paper states. “Transitioning away from fossil fuels is more than replacing one energy source with another … the transition itself is complex.” Many others simply do not have the financial headroom to invest in renewables due to looming debt payments and empty balance sheets. “We must confront economic dependence on fossil fuels that shape the realities we face,” Tuvalu’s delegate said. “Unsustainable debt, reliance on fossil fuel revenues, and a global financial system that was not built for us, and too often fails us.” The coalition also recognised the limits of its own power. While the alliance contains a meaningful contingent of major fossil fuel producers – Norway, Canada, Australia, the United Kingdom, Brazil, Mexico, Nigeria, Angola and Colombia itself – what it does not contain is a critical mass of global fossil fuel supply or demand. The 57 countries present make up about a fifth of global fossil fuel production, a third of oil and gas demand, and the same share of world economic output. The five biggest fossil fuel producers – the United States, China, Russia, India and Saudi Arabia – were all absent. Together, they control nearly half the world economy, and pump about 45% of the world’s oil, half its natural gas and three-quarters of its coal, far outstripping the heft of the Santa Marta coalition on all fronts. “We are here with an immense group, and yet it is still too small a group for what our ambition actually is,” van Veldhoven said. “Let’s make sure that we continue to drive this process as an open coalition. That means we have to ensure visibility of the outcomes and use that as an invitation to others to join us.” Rockstars to the rescue Attendees gather for the launch of the Science Panel for the Global Energy Transition (SPGET) in Santa Marta. A concrete outcome of the summit is the creation of a new scientific panel to advise nations on the practice and policy of the fossil fuel phase-out, an idea born in the halls of COP30, which Vélez Torres pitched as a sort of climate scientists’ Avengers team of “rock star academics”. “This panel not only repairs a historical debt of an organisation dedicated, finally and for the first time, to overcoming fossil fuels in the energy matrix,” she said, “it will also tell us about other types of challenges regarding the social and economic limitations of being able to carry out this transition as quickly as possible.” The Science Panel for the Global Energy Transition (SPGET) will unite over 100 scientists and academics to guide nations in policymaking and emissions pathway analysis with the goal of keeping the 1.5°C warming target enshrined in the Paris Agreement alive. The independent panel will focus on mapping policy options, green technologies and financial mechanisms that can be harnessed by countries to reduce emissions and fossil fuel dependence. Johan Rockström, director of the Potsdam Institute for Climate Impact Research and co-lead of SPGET, said it will operate as a “scientific service” to governments, helping them figure out the balance of energy supply and demand with a “scientifically aligned, just and orderly phase out of fossil fuels.” “[The panel] will also enable us to have feedback into the COP process so that we can keep the fossil fuel phase-out discussions in plenary at the COP meeting alive,” Rockström said. “Now is the moment to tip the scales, to not allow anymore that a few actors at the COP meetings always block the most important discussion of them all: the phase-out of coal, oil and gas.” The hard the work begins Delegates arrive for high-level ministerial sessions in Santa Marta, Colombia. The final agreement struck at Santa Marta establishes three “workstreams”: working groups of countries, experts and civil society that will meet between now and the next conference to develop policy options on the thorniest questions of the phase-out. The first will focus on national emissions roadmaps, taking specific aim at what Vélez Torres called the “punto ciego,” or blind spot, in the Paris Agreement: exported emissions. Under the Nationally Determined Contributions (NDCs) mandated in the Paris Accords, countries report emissions on a territorial basis, but not the emissions from fossil fuels they extract and sell to other countries. For major exporters, the effect on emissions calculations is enormous. Norway’s exported emissions from oil and gas are roughly ten times its territorial emissions. Saudi Arabia’s full emissions footprint rises to two and a half times its reported emissions, closing in on 5% of global CO2 on its own. “We are not making clear commitments about how we are going to control the emissions that are exported from producing countries,” said Vélez Torres, whose country, Colombia, sees its emissions more than double when its coal and oil exports are counted. “We want to be very clear, very honest about how to transition away from production as well.” Winding down production is one of the most complex questions in the phase-out debate. If demand falls first, producer countries face collapsing revenues and an economic crisis. If supply falls first, importers face energy shortages. A complementary workstream announced in Santa Marta, backed by the OECD, will look at how exporters and importers can coordinate their wind-downs so the two declines move in step, avoiding a scenario where one side pulls back faster than the other, leaving producers without buyers or importers without fuel before clean alternatives can fill the gap. Money traps, and future hopes Indigenous Peoples’ representatives played a central role in the Santa Marta phase-out talks. The final workstream, supported by the International Institute for Sustainable Development, takes on what the co-hosts called the three “traps” holding states back from moving faster on fossil fuel phase-outs: finance, debt and subsidies. It is, in many ways, the hardest of the three. Without alternative revenues lined up, governments cannot turn off the tap on production that pays their bills. The constraint tightens further as interest payments squeeze public budgets and credit ratings for developing nations render borrowing exceedingly expensive, leaving fossil fuel revenue indispensable and crowding out renewables investment. Then there are the subsidies. Governments worldwide handed roughly $1.3 trillion in direct support to fossil fuel producers and consumers in 2022 to keep pump and power prices low, according to the IMF, and as much as $7 trillion once the unpriced costs of pollution and climate damage are factored in. The direct figure alone is more than half the $2.4 trillion the world invested in the entire energy transition the same year, tilting the market against cheaper renewables as subsidies keep expensive fossil fuels price-competitive. In Ghana, the financial realities of fossil fuel dependence remain too steep to overcome, its delegate told the conference, despite the country supporting the phase-out goal. “In Ghana, fossil fuels remain deeply tied to government revenues that fund essential public services and to our broader energy systems,” he said. “We need a fossil fuel treaty that creates the necessary architecture for a just transition.” Ten-year-old Paula Pedro from Colombia speaks at the closing of the Santa Marta conference. That the coalition is willing to talk openly about the financial dependency at the heart of the phase-out is, for many participants, the most encouraging signal to come out of Santa Marta. Whether it can build bridges and expand its membership as the climate crisis accelerates is the question that will loom over COP31 in Antalya later this year, and in the run-up to Tuvalu in 2027. With the workstreams set and the next conference scheduled, it fell to a 10-year-old from Colombia to remind the room what the diplomacy was for. “Of the 12 million children we have in Colombia, eight out of ten of us are affected by fossil fuels and weather changes,” Paula Pedro, representing the Colombian children and youth coalition, told the assembly. “What we need, for the children, is that the people in this room do the math, but not only on paper, but accomplish change as a matter of fact.” “We’re not only the future,” Pedro said. “We are the present and beyond.” Image Credits: Colombian Environment Ministry, Colombian Environment Ministry, COP30, ColomColombian Environment Ministrybian Ministry o, Colombian Environment Ministry, Colombian Environment Ministry, Colombian Environment Ministry. Heartbroken Families Face Huge Structural Barriers When Trying to Prove Medical Negligence in India 01/05/2026 Arsalan Bukhari & Naila Tabassum Indian families face a huge struggle to get timely access to medical records of loved ones who have died in Indian health facilities, while the police can only lay a charge against a doctor if an independent medical expert first confirms negligence. NEW DELHI – India faces thousands of medical negligence cases every year, but structural problems make it extremely difficult for patients’ families to find out what has happened to their loved ones – let alone win compensation when treatment has been botched. “A shadow of death is looming over us,” Ashwini Bajaj, a Haryana-based businessman, told Health Policy Watch, recalling the treatment of his 24-year-old son, Deshbandhu, more than a year after his death. In December 2024, Deshbandhu, an MBA student at Punjab University and Bajaj’s only son, developed a fever that lasted more than two days. On 26 December, he visited a hospital near his university in Chandigarh, where he was prescribed medicines and given a series of tests, including a liver function test (LFT). By the time the results came out later that evening, Deshbandhu had returned to his parents’ home in Hisar, around 200 kilometres away. The next day, he went to a private hospital there, but his condition deteriorated rapidly. His oxygen saturation dropped to 65%, and doctors warned of acute liver failure. “We were told his condition was very critical and that the hospital did not have the resources to treat him,” Bajaj said. “We were asked to take him to a super-speciality hospital. It felt as if the ground beneath our feet had slipped away.” Deshbandhu was shifted to a major private hospital in Gurugram. “My son was there for over three weeks. His condition kept deteriorating. He went with jaundice, and he developed intestinal obstruction, kidney stress, and pneumonia,” Bajaj said. A few days after his 24th birthday, which was on 20 January 2025, Deshbandhu died. Bajaj says he has been unable to return to work. His case reflects broader systemic gaps in India’s healthcare system, where delays in critical care, weak referral systems, and limited transparency can have life-threatening consequences — and the lack of updated national data continues to hamper accountability. Transparency in treatment Deshbandhu Bajaj (24), a mountaineer and an MBA student who died in January 2025. His father, Ashwini Bajaj, alleges medical negligence. “Initially, I thought the doctors tried hard to save my child, but when I obtained all the medical reports, which took three to four months to obtain, I realised much time was lost before the actual treatment started,” Bajaj said. “When I made a day-by-day chart, I realised that, for at least four days, my son didn’t get the treatment he should have. “Every evening, I used to get payment requests promptly on my WhatsApp. If they could send payment requests, why can’t they share procedural updates the same way?” Rujhan Dhawan, a lawyer at the Punjab and Haryana High Court, told Health Policy Watch such opacity is a major barrier to accountability. “A patient, once admitted, is entirely dependent on the institution not only for treatment but also for truthful disclosure,” he said. “Critical information about procedures and complications is often not readily accessible to families.” Bajaj’s family spent over ₹30 lakh ($33,000) on treatment. He says he is not seeking compensation, but a legal framework that mandates transparency. Not an isolated case Deshbandhu’s case is not an isolated one. According to the 18th Annual MedLegal Review, 65,000 medical negligence cases were filed in India in 2025 alone. Radha Sharma (49), a resident of Rajasthan’s capital city Jaipur, died days after being given a TB drugs although she had been diagnosed with a liver-related illness. In Jaipar, around 270 kilometres from Gurugram, 55-year-old tax consultant Kishan Kumar Sharma is fighting a case linked to the death of his wife, Radha. On 3 March 2025, she developed mild jaundice and was admitted to a private hospital. A test suggested Budd-Chiari syndrome, a rare liver disorder. However, despite a negative tuberculosis test, Radha was prescribed the TB drug, Isoniazid, said Sharma. Isoniazid should not be prescribed to patients with liver disease who have bilirubin levels over 4 mg/dL, according to World Health Organization (WHO) guidelines. But Sharma says his wife’s liver disorder was overlooked. Radha’s condition deteriorated rapidly, and she died on 18 March. “I have a simple question,” Sharma said. “Why was my wife given Isoniazid? Was it part of any established protocol or something else?” The risks highlighted by such cases reflect a broader global problem. According to the WHO, an estimated 138 million patients are harmed every year due to unsafe medical care. Lack of dedicated investigative body Nishant Bharihoke, an advocate at the Delhi High Court who specialises in medical negligence cases, told Health Policy Watch the core issue lies in the absence of a dedicated independent investigative framework. “India does not have a dedicated body specifically tasked with investigating deaths or serious injuries caused by medical negligence,” he said. “When a patient dies, and the family suspects wrongdoing, there is no authority whose sole function is to find out what happened.” Complaints are typically routed through State Medical Councils, which may form inquiry committees. Their decisions can be appealed to the National Medical Commission, but Bharihoke argues that the system is structurally limited. “The National Medical Commission’s primary mandate is to regulate medical education. Its disciplinary board has no independent investigators and no power to enter hospitals and examine evidence,” he said. He also pointed to a legal loophole: since these proceedings are not strictly judicial, false statements made before such bodies do not result in perjury charges. For families like Bajaj’s and Sharma’s, he said, this gap deepens the sense of injustice. When cases turn criminal Simran Chhabra (21), a resident of Gurugram and MA student at Amity University, was suffering from a simple cough and cold. She died within minutes of being administered an intravenous injection. The family is fighting a medical negligence case in a Gurugram court. The gap becomes even wider when negligence overlaps with criminal allegations. One such case is the death of 21-year-old Simran Chhabra. On 21 January 2023, she visited a private hospital in Gurugram with symptoms of cough and cold. According to a prescription her brother, Sourabh Chhabra, shared with Health Policy Watch, she was administered an intravenous injection of Dynapar. This is usually used to treat pain and inflammation associated with arthritis or after surgery. “As soon as the injection was fully administered, Simran collapsed on the bed and froth began coming out of her mouth,” Sourabh said. “Everything happened within minutes. I had no time to understand what was going on.” She was referred to another hospital, where she was declared dead. According to Bharihoke, the family’s legal representative, the doctor later claimed that multiple emergency interventions were carried out, including five additional injections and cardiopulmonary resuscitation (CPR), using drugs typically administered in cases of severe allergic reactions. However, the post-mortem report reviewed by Health Policy Watch raises questions. It records only two puncture marks on her body, and there is no mention of a cannula (an intravenous tube) being used. If multiple injections were administered, the family asks why there is no corresponding physical evidence. In this case, they argue, the medical account and post-mortem findings do not align. “Forget conviction or arrest, even registering an FIR in such cases often requires court intervention,” Bharihoke said. A FIR is a First Information Report (FIR) in Indian medical negligence cases, a formal document prepared by police under Section 154 of the Criminal Procedure Code upon receiving information about alleged criminal negligence. Absence of a legal framework Several structural barriers insulate medical health practitioners against negligence cases, according to legal experts. “In India, police usually cannot even register a case against a doctor unless an independent medical expert first confirms negligence,” Bharihoke told Health Policy Watch. “In most cases, doctors are reluctant to give such opinions, especially against their peers.” The challenge is compounded by access to evidence. Hospitals retain control over key records, case files, prescriptions, nursing notes, and CCTV footage while families often receive only partial or delayed documentation. India also lacks a statutory system guaranteeing timely access to medical records for patients and their families. There is no clear legal mandate requiring investigators to immediately secure hospital evidence. Tanvi Dubey, a Supreme Court lawyer, told Health Policy Watch the legal framework itself raises the bar for accountability. “Criminal liability in medical negligence cases is limited to gross negligence, not simple errors of judgment,” Dubey said. “This significantly narrows the scope for prosecution.” Even initiating an investigation can be delayed: “Authorities are allowed to conduct preliminary inquiries before registering a case, which often means waiting for medical opinions and slows the process.” Dubey also pointed to the continued reliance on what is known in Indian law as the “Bolam principle,” where a doctor’s actions are judged against a body of medical opinion. “This makes expert testimony central. Unless a complainant can produce strong contrary evidence, it becomes very difficult to establish negligence,” she said. While multiple legal remedies exist, including consumer courts, civil litigation, and disciplinary proceedings, Dubey noted that each comes with limitations. “Criminal prosecution is rare, civil cases are slow and evidence-heavy, and disciplinary proceedings do not always ensure compensation or thorough fact-finding,” she said. Compared with Western peers, India faces two major policy gaps in patients’ treatment: the absence of a national electronic medical record (EMR) system, and the lack of a digital system connecting labs directly to the consulting doctor. Currently, India doesn’t have a mandatory EMR policy applicable to healthcare organisations. Even today, prescriptions, clinical notes, and drug administration records are still handwritten in the majority of hospitals and almost all smaller clinics. This makes them more vulnerable to tampering, loss and destruction. The absence of a nationwide electronic medical record system adds another layer of opacity. In many facilities, records remain handwritten and vulnerable to alteration; a gap Bharihoke alleges was evident in Simran’s case. Urgent reform is necessary India’s Minister of Health Jagat Prakash Nadda. Legal experts are calling on authorities to establish an independent statutory body to investigate medical negligence. Only families with the financial means and emotional capacity to pursue long legal battles are able to take up medical negligence cases. For many others, the burden becomes too heavy to carry. While the rules may appear neutral on paper, experts say their impact is deeply unequal. Legal and policy experts argue that the most urgent reform is structural, particularly the creation of an independent statutory body tasked solely with investigating patient safety incidents, particularly in cases involving death, permanent disability, or serious injury. Such a body should have the authority to enter hospital premises, access medical records, secure CCTV footage, and record statements. Its findings should be made public, while the evidence it collects remains protected from use in criminal or disciplinary proceedings. In England, the Health Services Safety Investigations Body (HSSIB), established in 2023, follows this approach by conducting independent investigations into patient safety incidents. Globally, different systems offer alternative approaches to accountability. In the United States, oversight is spread across multiple layers: state medical boards regulate conduct, a national database tracks malpractice records, hospitals report serious incidents, and patients can pursue civil litigation. China follows a three-tier system, allowing patients to first negotiate with hospitals, then seek mediation, and finally pursue civil lawsuits. In parts of Europe, including France and the Nordic countries, no-fault compensation systems allow patients to receive compensation without proving negligence, making the process more accessible and less adversarial. Aviation and rail safety investigations have long operated on similar principles, focusing on systemic failures rather than individual blame. For India, experts say the lesson is clear. Accountability frameworks do not have to rely solely on litigation. A system built on independent investigation, timely access to evidence, and patient-centric redress could help provide answers to families like the Bajajs and Sharmas. Image Credits: César Badilla Miranda/ Unsplash, Felix Sassmannshausen. No Pandemic Agreement Annex by World Health Assembly, Says Civil Society 30/04/2026 Kerry Cullinan (Left to right from top) Third World Network’s moderator and speakers Lauren Paremoer, KP Gopakumar and Tamara Prisenburg form AIDS Healthcare Foundation. The final missing piece of the Pandemic Agreement – a pathogen access and benefit-sharing (PABS) system – is unlikely to be agreed on by the World Health Assembly (WHA) later this month. This was the view of civil society observers of the talks taking place at the World Health Organisation (WHO) headquarters in Geneva, who briefed the media on Thursday. The sixth round of talks is scheduled to end late on Friday night (1 May). Earlier in the week, WHO Director General Dr Tedros Adhanom Ghebreyesus told a Geneva media briefing that “key differences remain on key issues”. “I still see a common will to reach consensus, which means I continue to believe there is a way to reach consensus,” Tedros added. Although the notion of a “hybrid” PABS system is being discussed informally, its proponent, the European Union (EU), has not presented any formal text, Third World Network’s (TWN) KM Gopakumar told the media briefing, which was hosted by TWN and the AIDS Healthcare Foundation. While Brazil and Botswana have apparently indicated that they might support a hybrid or “blended” compromise, the Africa Group is opposed to it, according to the civil society representatives. WHO member states are negotiating how to share both information about dangerous pathogens and some of the “benefits” that manufacturers may develop from that information – namely, vaccines, therapeutics and diagnostics (VTDs). The “hybrid” or “blended” proposal is a mix of mandatory and voluntary measures for sharing pathogen information and any benefits that flow from this information. It de-links information-sharing and benefit-sharing. Gopakumar said that, in terms of the blended agreements, countries that shared pathogens “will have the freedom to choose to attach certain conditions for sharing the data and the sample, including benefit sharing requirements” or share without any conditions. Kill the efficiency Shifting the choice to individual countries would undermine the efficiency of a single PABS system as users would need to negotiate with the individual countries instead of through a centralised system, he argued. “If you have a hybrid system, first of all, it kills the efficiency [of a single system], and second, it’s going to debase the access and benefit sharing norms set by the international instruments like the Convention on Biological Diversity and the Nagoya Protocol. Any attempt to dilute benefit-sharing obligations would be a “disaster” for equity, said AHF’s Tamara Prisenberg. Lauren Paremoer of the People’s Health Movement said that the blended model introduces “a two-track system for accessing pathogens” that violates access and benefit-sharing on an “equal footing” specified in Article 12 of the Pandemic Agreement. One track would allow anonymous users to access pathogen data without upfront commitments to benefit-sharing or legally binding contracts. The other was in line with Article 12, permitting access to pathogens through databases and laboratories that would require users to register and commit to specified benefit-sharing. Earlier in the day, the Intergovernmental Working Group (IGWG) briefed civil society on text-based negotiations, but very little of the text they shared had been “greened” to show agreement. EXCLUSIVE: WHO Opens Nominations for Next Director General; Germany May Advance Former Merkel Aide, Helge Braun 30/04/2026 Felix Sassmannshausen, Elaine Ruth Fletcher & Editorial team WHO DG Dr Tedros Adhanom Ghebreyesus issued a call for nominations for the DG elections. He recently travelled to Berlin, where he met with high-level politicians and the WHO’s Pandemic Intelligence team. As the World Health Organization (WHO) formally opens the nomination process for the next Director-General, Germany now appears likely to propose Helge Braun, Chief of Staff in former Chancellor Angela Merkel’s government, according to Berlin insiders. But after slashing its global health budget, sources question whether a German candidate can win wide support from other WHO member states. WHO Director-General Dr Tedros Adhanom Ghebreyesus has formally issued a call to WHO member states for nominations to the DG elections, scheduled for May 2027, in an invitation sent on 24 April to all WHO member states. WHO confirmed this in an email to Health Policy Watch. The invitations had been sent via private letters to countries’ Geneva missions. The period in which member states may nominate candidates will now run for six months, until 24 September. Contenders who have until now remained in the shadows are expected to begin coming forward publicly with their candidacies at the World Health Assembly in May. From the German perspective, Berlin wants its financial weight reflected in executive influence at the multilateral level as the largest global health donor following the US withdrawal from the WHO in January 2025. The withdrawal, combined with the US non-payment of dues owed, thrust WHO into a budget crisis, prompting layoffs of about 25% of the workforce in the past year. German Foreign Ministry neither confirms nor denies The German Foreign Ministry, formally responsible for the nomination, declined to confirm or comment on Braun’s potential candidacy when responding to a query by Health Policy Watch. Germany’s other potential candidates include the contested former Health Minister Karl Lauterbach and the lesser-known Paul Zubeil. In contrast, Braun’s dual profile as an accomplished politician, skilled financial manager, and trained physician and researcher who successfully built cross-party bridges offers a distinct advantage. But he is little known outside of Germany. Bridge-builder with executive and medical expertise Former Chair of the influential German Budget Committee, Helge Braun (right), and former French Chair of the Finance Committee, Claude Raynal (left), in the Bundestag. The current WHO leadership landscape demands a candidate capable of managing deep institutional fractures and uniting a divided global community. Despite him being largely unknown in the international community, Germany could be expected to emphasise Braun’s extensive fiscal and crisis management experience in any candidacy it mounts. As ‘Head of the Chancellery’, effectively Chief of Staff, in Angela Merkel’s last term as Chancellor, from 2018 to 2021, Braun operated at the nexus of scientific advice and political implementation during the COVID-19 pandemic, notably comparing the Chancellery to an intensive care unit where acute problems must be solved. Between 2021 and 2025, Braun then chaired the powerful Budget Committee of the German Bundestag (Parliament), overseeing the distribution and management of hundreds of billions of Euros with strict discipline This profound understanding of macroeconomic management, coupled with his pragmatic defence of Germany’s controversial debt ceiling alongside crisis-driven special funds, makes him an attractive prospect for donor nations currently demanding more financial accountability and restructuring at WHO in Geneva. Serving as a central mediator across government ministries, Braun built a reputation as a highly pragmatic problem solver whose past domestic political affiliations will not necessarily dictate his future approach to global health governance. This pragmatism complements his longstanding political advocacy for research into infectious diseases like Ebola and malaria. And unlike many career politicians, Braun’s foundational expertise lies in medicine, having worked for years as an intensive care physician and anaesthesiologist. He returned to these roots in April 2025 by assuming the presidency of the University of Lübeck, an institution renowned for its focus on life sciences and artificial intelligence. Why the candidacy might spark concerns WHO member states are currently negotiating a pathogen access and benefit-sharing (PABS) system in Geneva. While Braun championed early interventions and massive digitisation projects in his role as Merkel’s Head of the Chancellery during the COVID pandemic, severe bureaucratic delays hampered the rollout of vaccination campaigns and testing strategies. This tarnished his crisis management legacy just as he exited the federal government. His domestic political capital suffered further damage during the December 2021 Christian Democratic Union leadership election, where he lost heavily to conservative rival Friedrich Merz, now Chancellor. Party members largely rejected Braun as an establishment candidate, perceiving him as too closely aligned with the moderate legacy of former Chancellor Angela Merkel. Additionally, it is questionable whether Braun would wield the necessary diplomatic connections and familiarity with foreign health systems to be effective on Day One of a term as WHO head. The Director-General must immediately command trust and authority on the international stage, particularly when dealing with health ministries and stakeholders in the Global South. Most notably, the German government opposed the release of COVID-19 vaccine patents during his tenure, drawing sharp criticism from international health equity advocates. Defending this refusal in May 2021, Braun wrote in a guest article for the German newspaper Die Zeit that “patent protection as a driver of innovation is not the problem in this crisis, but an essential foundation for its solution.” In the Global South, this track record could thus reinforce the perception that Germany defends pharmaceutical interests over equitable technology transfer – especially in the face of current PABS Annex negotiations. Recent reports from Tagesspiegel Background indicating that the former minister was approached by Germany’s Association of Research-Based Pharmaceutical Companies to become their next president, when the post becomes vacant at the end of 2026, might further fuel these concerns. Finally, Germany has been cutting back its Official Development Assistance (ODA) in general, including contributions to the World Health Organization, where it has historically been the largest member state donor after the United States. On Wednesday, the Merz government announced its 2027 budget plans with further ODA cuts following last year’s drastic 17% reductions. The likelihood of Germany fulfilling its original 2024 financial pledge to WHO for the current biennium (2026-27) also remains in doubt. “They can put forward a candidate, but I don’t think it’s going to get a lot of traction from other member states,” said one informed WHO source. “At a time when Germany is reducing global health funding to member states, I don’t think they can go ahead and claim the top seat.” Step back and support allied candidates? Braun served as Head of Chancellery under then German Chancellor Angela Merkel, seen here with WHO Director General Dr Tedros in Berlin in 2021. Furthermore, domestic opinion remains highly divided on mounting a campaign amidst the geopolitical strains on Chancellor Friedrich Merz’s coalition and Tedros has reportedly urged Germany to back allied candidates instead. At the same time, the desire to seize more leadership in the UN system remains strong after Germany’s failed previous attempt to secure the top role at the UN High Commissioner for Refugees in 2025. Currently, Germany is also pushing for another attempt at a UN Security Council seat. Should Germany put forward a candidate, Foreign Minister Johann Wadephul, who will make the final decision, also faces a stark choice between Braun and the better-known Karl Lauterbach, as well as Paul Zubeil with his strong international health and technical background. Advancing a WHO outsider like Braun against established public health veterans is a highly calculated risk for Berlin, which must first convince other European countries to rally behind him. In case Berlin formally nominates Braun, the success of his candidacy will depend entirely on how effectively the government can reframe his perceived lack of field experience and global networks as delivery on fresh, badly needed fiscal expertise and perspectives. Grappling with WHO’s funding crisis As the race for the next Director-General opens for formal nominations, the names of over a dozen high-profile potential candidates are still circulating – from Indonesia to the United Kingdom. Want to Become the Next WHO Director-General? Get in Line And the list is still growing. Among the newer names being floated is that of Dr Hanan Mohamed al-Kuwari, who served as Qatar’s Minister of Public Health until November 2024 and chaired the 153rd Session of the WHO Executive Board. Before joining the Hamad Medical Corporation in 1996, where she ultimately rose to managing director, al-Kuwari worked for Reuters and as a freelance health reporter. Holding a PhD in healthcare management from Brunel University and bringing early career experience from the WHO, she represents a highly networked voice from the Arab world, celebrated for her crisis resilience and for shaping the WHO’s recent global work programme. Dr Maria Neira, former WHO Director of Climate, Environment and Health Another candidate who has been mentioned is Spain’s Dr Maria Neira, who recently retired from WHO as the director of Climate, Environment and Health. An iconic spokesperson for the climate, environment and health movement, Neira is known as a telegenic personality and adroit politically. As a young medical doctor, she worked in emergency relief in Latin America and Africa, and later served as Spain’s Vice Minister of Health and Consumer Affairs as well as President of the Spanish Food Safety and Nutrition Agency. However, Spain also recently decided to nominate a candidate to head the UN Food and Agriculture Organization (FAO), when Qu Dongyu’s second term as Director General ends in July 2027, leaving doubts about whether it would want to mount yet another campaign, in parallel. Continuing decline in ODA and global health aid Drastic ODA cuts and reduced global health funding leave vulnerable populations in precarious conditions worldwide. Whoever is elected will have to continue grappling with the continuing long-term declines in donor-driven ODA, and particularly global health aid – directly to countries and to WHO. While WHO 2026-2027 $4.2 billion base budget is now 85% financed, according to Tedros’ comments on Wednesday, declines in ODA continue to cast uncertainty on how the remaining $630 million gap will be filled. It’s unlikely that the $260.6 million in assessed US contributions still due for years 2024-2025, before the withdrawal became official in January, will ever be repaid, conceded WHO’s Tedros at a Geneva press briefing on Wednesday. “We’re hoping to get the money, but no signals yet,” Tedros told journalists, adding: “No signals means maybe we may not be able to get the money. The likelihood could be not getting the money.” “We’re looking at nontraditional donors. We’re looking at international financial institutions and other ways to mobilize that 15%,” Tedros said, in terms of filling that gap. “It’s not that we won’t go to the traditional donors, but I think we’re expanding that donor base.” This article has been edited to reflect additional information regarding Dr Hanan Mohamed al-Kuwari’s early career as a freelance journalist. Image Credits: X/Dr Tedros, Deutscher Bundestag/Leon Kügeler, European Commission. 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Investing in Midwives is Essential to Improve Sexual and Reproductive Health 05/05/2026 Teguest Guerma A midwife examines a pregnant woman. The International Day of the Midwife (May 5) reminds us that safe birth is not a stand-alone event, but part of the broader continuum of sexual and reproductive health and rights Most maternal deaths occur during labour, birth, or shortly after birth. Nearly 290,000 women died during and following pregnancy and childbirth in 2020, with 95% of these deaths occurring in low- and lower-middle-income countries. The major causes included severe bleeding, hypertensive disorders, infections, complications from unsafe abortion, and obstructed labour. Yet these events are largely preventable or treatable when skilled care, referral, medicines, blood, and emergency obstetric services are available. Midwives are often the first – and sometimes only – skilled provider able to detect and respond to such complications in a timely manner. But the world currently faces a shortage of up to a million midwives – part of a larger global health workforce crisis – that is concentrated in the countries and communities where maternal and newborn mortality is highest. Although skilled birth attendance globally is around 80%, this figure hides severe inequities within and between countries. Women in rural areas, poor households, conflict settings, humanitarian crises, and marginalized communities are least likely to have access to a skilled midwife or other qualified birth attendant. Access is not only about whether a health care facility exists, but also depends on distance, transport, user fees, staffing, respectful care, medicines, referral systems, and whether women trust the system enough to use it. Safe birth and post-natal care are not standalone events. They are part of the broader continuum of sexual and reproductive health and rights that includes health education, contraception, antenatal care, screening of sexually transmitted infections, safe birth, emergency response, postnatal and newborn care, breastfeeding support, and referral, as well as safe abortion and post-abortion care. High maternal mortality ratio The current global maternal mortality ratio of 223 deaths per 100,000 live births is well above the Sustainable Development Goal target of achieving less than 70 deaths per 100,000 live births by 2030. Midwives can provide around 90% of essential SRHR care when they are educated, licensed, regulated, and supported to international standards. But in many low-resource settings, midwives are too few, poorly distributed, underpaid, ill-equipped, or not fully authorized to practice to their competencies. Scale-up to achieve universal coverage of midwife-delivered interventions is one of the clearest and most practical routes to faster progress and to averting a larger share of maternal and neonatal deaths and stillbirths. Investment in the workforce must include education, fair pay, regulation, safe working conditions and career pathways, supplies, data systems, and integration into primary health care. Policy settings need to remove financial barriers to care and treat SRHR as a complete package, rather than as a range of isolated services. Countries are demonstrating increasing innovation in the midwifery field. In Sierra Leone, for example, structured preceptorship (mentorship) programmes are strengthening hands-on clinical skills and confidence among midwives, helping translate training into safer care at the bedside. In Ethiopia, a center of excellence in midwifery trains disadvantaged rural girls to become ethical and compassionate midwives in their own communities. Efforts such as these are key to empowering midwives and the women and children they serve before, during and beyond childbirth. Midwives already save lives every day. The task now is to ensure that they can do so for women everywhere. Dr Teguest Guerma is the founder and CEO of LeDeG Midwifery College, established in 2015 to address critical gaps in maternal health across Ethiopia and beyond. Image Credits: Elizabeth Poll/MMV, Twitter: @WHOAFRO. Pandemic Talks Extended – But Colombia Appeals for New ‘Method’ to Settle Differences 04/05/2026 Kerry Cullinan South Africa, speaking for the Africa Group and Group for Equity. Colombia has appealed for a new “method” to settle the outstanding annex of the Pandemic Agreement, after World Health Organization (WHO) member states failed to reach agreement last week after almost a year of talks. Talks on a Pathogen Access and Benefit Sharing (PABS) system were due to wrap up last Friday night, but have since been extended to July, with a resolution in that regard being prepared for the World Health Assembly, which starts on 18 May. “There is one fundamental point that we request be included in the resolution: extending the negotiating period makes no sense unless the negotiating method is changed,” Colombian Ambassador Germán Velásquez told the Intergovernmental Working Group (IGWG) shortly before the meeting closed last Friday evening. “It is not possible to continue seeking consensus in the same way. Why not introduce the concept of ‘progressive consensus’? Once a majority has been reached on specific points, a vote should be held if necessary, and negotiations should continue.” Colombia is part of the Group for Equity, a large cross-regional alliance of countries that has been pushing for a PABS annex that ensures the inequity of the COVID-19 pandemic, where wealthy countries commandeered all the scarce vaccines, is not repeated. The proposal for voting also has the support of some civil society groups, notably Pedro Villardi, from Public Services International, a trade union federation with over 30 million members. “If we need [to reach an agreement], why don’t we vote? We have a majority of countries pushing for equitable provisions… and we have a few countries that are opposing these measures and defending the position of the pharmaceutical industry and other big corporations,” Villardi told a recent briefing on the negotiations. Increasingly frustrated The Group for Equity and the Africa Group – which represent the vast majority of member states – have become increasingly frustrated by what they see as developed countries protecting the interests of their pharmaceutical companies instead of levelling the playing field ahead of future pandemics. The PABS system is due to govern how dangerous pathogens are shared during public health emergencies and how any medical products (benefits) that accrue from this information are shared. The dispute, mainly between developed and developing countries, hinges on how countries that share pathogen information can benefit from any vaccines, therapeutics or diagnostics (VTD) developed as a result. The Group for Equity and Africa want mandatory benefit-sharing, with the terms set out in standard contracts between the WHO and pharmaceutical companies. Several European countries – notably those with powerful pharmaceutical industries – argue that compulsory benefit-sharing will stifle research and development. According to the current draft, the WHO will receive a donation of 10% of vaccines or medicines produced by pharmaceutical companies that sign up to PABS – but only during a pandemic, not a public health emergency of international concern (PHEIC). ‘Deep regret’ At the close of last week’s talks, South Africa – unusually speaking both for Africa and the Group for Equity – expressed “deep regret” that IGWG is “still far from reaching consensus on the text of the Pandemic Agreement annex”. “We have engaged constructively and in good faith, including by putting forward concrete proposals. We also considered other approaches, but found, ultimately, that these fall short of the IGWG mandate to deliver a PABS annex that preserves the principle of an equal footing between access and benefit sharing,” said South Africa. “Approaches that risk decoupling these elements, or introducing fragmentation from the outset, are not sustainable foundations for the system we are tasked to build, and may only legitimise the unfair status quo regarding access to essential health products,” added South Africa, referring to a “hybrid” proposal put forward by some European countries during informal negotiations. The two groups are “strongly united” on a PABS system that is “fair, equitable and capable of correcting long-standing imbalances, including inequitable access to VTDs and unjust extraction of our genetic resources”, said South Africa. “A credible landing zone requires legal certainty at a point of access on how benefit-sharing obligations will be operationalised and enforced. This is neither excessive nor unreasonable. It is fundamental to trust in the system.” Convergence Nepal, speaking for Southeast Asia, warns against weakening the link between access and benefit-sharing. Nepal, speaking for WHO’s South East Asia region, stressed “the importance of ensuring that the PABS system preserves the intrinsic linkage between access and benefit-sharing. “Approaches that risk weakening this relationship or introducing fragmentation from the outset would not provide a sustainable or equitable foundation for the system we are mandated to establish,” Nepal cautioned, apparently also in reference to the “hybrid” option. Meanwhile, another diverse group represented by the Dominican Republic, but including Australia, the Bahamas, Barbados, Malaysia, Mexico, Norway and Singapore, offered to be a bridge to find “convergence” for a “sufficiently clear, credible and operationally effective” PABS system. Meanwhile, the EU also expressed regret at the failure to reach agreement, expressing its full commitment to “finalise and agree on a PABS system that will make a real difference and truly change things on the ground”. The European Union regrets that IGWG was unable to reach agreement on PABS. ‘Disservice to humanity’ The next IGWG will be from 6 to 17 July, and the new aim is for a PABS annex to be ready for next year’s World Health Assembly. Closing Friday evening’s session WHO Director General Dr Tedros Adhanom Ghebreyesus acknowledged that the talks have been “a roller coaster”. “Real progress was made on the PABS annex, but important differences remain. Please stay engaged. We need everyone. My one piece of advice is this: please approach the outstanding issues with a sense of urgency, because the next pandemic is a matter of when, not if,” said Tedros. Echoing this warning, Helen Clark and Ellen Johnson Sirleaf, co-chairs of The Independent Panel for Pandemic Preparedness and Response, said that “a lack of action to prevent and prepare for the next pandemic threat is a disservice to humanity”. They called on governments to do more on pandemic prevention, preparedness, and response (PPPR): “All countries must be able to detect and rapidly report outbreaks which may pose an international threat.” However, they also acknowledged that many low- and middle-income countries are impacted by high debt levels, and a sharp decline in development assistance. “Leaders have an opportunity to demonstrate their commitment to protect humanity at the upcoming UN High-Level Meeting on PPPR in New York in September. “There, they must make progress to fill enduring gaps in PPPR including on co-ordination, financing, equity, and accountability. They should also make it clear that the PABS Annex must be finalised to enable the WHO Pandemic Agreement to proceed.” Methane Emissions From Fossil Fuels Near Record Highs 04/05/2026 Stefan Anderson An infrared camera reveals escaped methane emissions from oil rig. Methane leaks from oil and gas make a major contribution to global warming. Methane emissions from fossil fuels stayed near record highs in 2025, with no sign of decline despite proven, low-cost ways to reduce them, the International Energy Agency (IEA) said on Monday. “Methane emissions from the energy sector plateaued near record highs,” the IEA found in its annual Global Methane Tracker. “There is still no sign that methane emissions from fossil fuel operations are falling, despite well-known and proven mitigation pathways.” The findings land halfway towards the 2030 deadline for cutting global methane emissions by 30%, a target that 159 countries and the European Union (EU) set under the Global Methane Pledge. A UN assessment released at COP30 found nations were on course to deliver less than a third of that. Methane is responsible for nearly 30% of the rise in global average temperatures since the Industrial Revolution. With an atmospheric lifespan of around 12 years, against centuries for carbon dioxide, cutting it is one of the fastest available levers on near-term warming, often described as the climate “hand brake”. More than half of global oil and gas output is now covered by company pledges to near-zero methane emissions, up from less than 20% in 2021. But the report found a “large implementation gap” between commitments and outcomes. “Countries and companies have raised their ambitions on methane, moving the issue higher up the policy agenda,” said Tim Gould, the IEA’s chief energy economist, who presented the findings at a high-level event in Paris convened by France’s G7 presidency. “However, setting reduction targets is only a first step, and it is important to ensure they are backed up by policies, implementation plans and real actions.” Fossil fuel production drives methane Oil, gas and coal production reached record levels in 2025, the IEA found. While the report found the global average upstream methane intensity of oil and gas production has fallen by around 10% since 2019, the IEA estimates total methane emissions from fossil fuel activities remain at 124 million tonnes a year, equivalent to the annual emissions of around three billion cars. Methane is the main component of natural gas and is emitted across the fossil fuel supply chain: vented from equipment by design, flared incompletely, leaked from valves, pipelines and storage tanks, or released from coal mine ventilation shafts, inextricably tying methane emissions levels to oil, gas and coal production. Oil is its largest source, releasing the equivalent of around two-thirds of the EU’s annual gas imports. Coal follows closely, then natural gas, the report found. A further 20 million tonnes comes from the incomplete burning of wood, charcoal and other traditional fuels in developing economies, principally used for cooking. Around 70% of methane emissions from fossil fuel operations could be cut using existing technology, the IEA said, with more than 35 million tonnes avoidable at no net cost as the price of gas offsets the investment needed to capture it. “This is not only a climate issue,” Gould said. “There are also major energy security benefits that can come from tackling methane and flaring, especially at a time when the world is urgently looking for additional supply amid the current crisis.” European Union energy chief Dan Jorgensen, speaking at the G7, added that capturing the gas being lost would significantly ease pressure on global markets. “We could have three times more gas on the market if we eliminated this waste,” Jorgensen said. “This shows that methane abatement and energy security are not competing priorities.” “Methane is the single fastest lever we have to limit near-term warming. We can no longer wait to pull this lever.” Pledges expand, emissions don’t The push for methane action accelerated at COP26 in Glasgow in 2021, where the United States, the EU and more than 100 other countries launched the Global Methane Pledge. The pact now covers 159 countries and nearly three-quarters of global oil and gas production. Five years on, COP26 president Alok Sharma, who guided the methane pledge across the line, said action is not living up to the scale required to abate the climate crisis. “Things are looking much bleaker than they were,” Sharma told a high-level meeting at IEA headquarters on Friday. “We breached 1.5°C last year and the year before, temporarily, and frankly, the prognosis is not good.” With no decline in fossil fuel emissions globally in 2025, atmospheric methane concentrations continued to rise. The IEA estimates that more than 85 million tonnes of fossil-fuel methane in 2025 came from the 10 biggest emitters: China, US, Russia, Iran, Turkmenistan, India, Venezuela, Indonesia, Kazakhstan and Iraq. Together, they account for around 70% of global fossil fuel methane emissions. The methane intensity of oil and gas production, or emissions per unit of energy delivered, varies widely, with the best performers scoring more than 100 times better than the worst, according to IEA data. Norway has the lowest upstream intensity in the world, the IEA found, achieved through a national ban on non-emergency flaring and a tax on venting and flaring introduced in 2015. Producers in the Middle East, including Saudi Arabia and the United Arab Emirates, also perform relatively well, according to the report. Turkmenistan and Venezuela have by far the highest intensities, the result of ageing Soviet-era and decrepit state-run infrastructure operating with little regulatory oversight. Independent analysis from the Stop Methane Project at UCLA found Turkmenistan dominated the list of the 25 worst-emitting facilities globally in 2025, emitting a “mind-boggling” amount of methane experts say could be easily contained. If every country matched Norway’s methane emissions intensity, global oil and gas methane emissions would fall by more than 90%, the IEA found. “Action on methane is not a fight of any single actor and nobody can win it alone,” French environment minister Monique Barbut said at the Paris event. “We must be clear: the energy sector offers today the fastest and often the most cost-effective reductions.” COP presidents press for action The IEA report was previewed at a high-level event at the agency’s Paris headquarters last week, where the COP31 presidency, made up of Turkey and Australia, set out priorities for the November summit in Antalya. Laurent Fabius, the former French prime minister who shepherded the Paris Agreement at COP21, said methane should be a central focus in Turkey, where the UN Environment Programme is expected to release its annual Eye on Methane report. Last year’s edition, launched at COP30 in Belém, found current national commitments would cut global methane emissions by just 8% below 2020 levels by 2030, under a quarter of the pledge target. “Methane is the faster way of trying to diminish global warming,” Fabius said. “Progress has been made. Pledges do exist, efficient techniques too, but we know that it is not enough. Methane should be one of the stars of COP31.” Sharma also pressed the point on finance, which he said was still falling far short of what was needed. Global clean energy investment reached a record €2.3 trillion last year, but a third of what was needed by 2030. Only 10% had gone to hard-to-abate sectors, and more than 80% to East Asia, Europe and the United States. Excluding China, developing countries representing 30 to 35% of global emissions were not getting the finance they need, he said. “We’re still nowhere near the scale that we should be … If you want to transition away from fossil fuels, you need to provide the finance for people to do that,” Sharma said. “We need to make sure there’s grant support to help developing nations look at their regulatory regimes.” “There will be some people who will say, and they’ve said it in the past, that the COPs are not the place this nitty gritty discussion on finance. That’s wrong. That is totally wrong,” Sharma said. “It is absolutely the place where we ought to be having discussion about these details on finance.” Simon Stiell, the UN Climate Change Executive Secretary, framed the energy crisis triggered by the war in the Middle East as an argument for accelerating the transition itself, which would in turn cut methane at source by reducing demand for the fossil fuels that produce it. “Those who’ve fought to keep the world hooked on fossil fuels are inadvertently supercharging the global renewables boom,” Stiell said. “This latest fossil fuel cost crisis has made the economic logic of renewables impossible to ignore.” “Renewables offer safer, cheaper, cleaner energy that can’t be held captive by narrow shipping straits, or global conflicts,” Stiell said, adding that “slashing methane” should be one of the most urgent priorities of COP31 for its potential to deliver “fast climate benefits while saving money.” Clean cooking and the bioenergy gap Around 18 million tonnes of methane emissions in 2025 came from the roughly 2 billion people worldwide who cook on open fires or simple stoves burning wood, charcoal and agricultural residues, with serious consequences for human health and the environment. Nearly half of them live in sub-Saharan Africa, where four in five households have no access to clean cooking technology, according to data released at the IMF Spring Meetings. The smoke produced exposes mostly women and children to particulate matter and carbon monoxide, driving severe respiratory and cardiovascular disease. Cooking with solid fuels is linked to 815,000 premature deaths a year globally, and household air pollution from these fuels remains one of the leading environmental health risks worldwide. “Expanding access to clean cooking solutions, including liquefied petroleum gas, electricity, improved biomass stoves and clean biofuels, offers further scope to cut methane emissions while delivering substantial health, gender and economic benefits in communities most affected by traditional biomass use,” the report said. Clean cooking is one of the COP31 presidency’s stated priorities, alongside electrification, zero waste and finance, representatives of the presidency from Turkey and Australia said. “Electrification, clean cooking, zero waste and finance, these are things that we can all gather around,” said Australia’s ambassador Stephen Jones, deputising for the country’s COP31 negotiations president. Jones said the climate transition and the response to the energy crisis were the same fight. “The clean energy solution is the solution to the energy crisis that we are now engaged in,” he said. “Paris is working. But we have to work faster and put more effort in.” Image Credits: Clean Air Task Force , IEA, IEA . Big Tobacco is No Longer Selling Cigarettes – It Is Engineering Addiction 04/05/2026 Hans Henri P. Kluge The tobacco industry is using sophisticated marketing aimed at young people. Europe needs a more precise focus to address the tobacco industry’s “engineered architecture of addiction”, featuring flavoured tobacco and nicotine products with ever more sleek designs. As an early champion of global tobacco legislation, the region can reposition itself to lead again – including through updated European Union directives on tobacco product regulation, advertising and taxation. Twenty-one years ago, the WHO Framework Convention on Tobacco Control (FCTC), the world’s first global health treaty and one of the EU’s earliest major public-health commitments, entered into force. It has helped to drive a reduction in tobacco use, with over 120 million fewer people using tobacco worldwide and best-practice protections expanded to more than six billion people. As a new WHO/ Europe report, published last year to mark the treaty’s 20th anniversary, shows, its core principles remain relevant – perhaps even more so today, as new products and tobacco industry tactics disrupt public health progress in unprecedented ways. Tobacco remains one of the world’s most lethal health hazards, killing more than seven million people globally each year, including an estimated 1.6 million non-smokers who are exposed to second-hand smoke. The WHO’s European Region, with 53 member states, has the dubious distinction of being the world’s leader in tobacco use, as well as the global leader in growing e-cigarette use among youth. Tobacco use trends (2000-2030) The scale is stark: in 2024 alone, 173 million adults and four million adolescents aged 13-15 were tobacco users, alongside 31.4 million adults and 4.2 million adolescents using e-cigarettes. What is increasingly evident today is that the danger is no longer confined to tobacco itself. It has shifted toward the engineered architecture of addiction – products designed to attract new consumers, sustain dependence and undermine public health. Flavours, filters, and sleek designs for Gen Z and younger The tobacco industry is much more than harvesting, curing, or rolling leaves. It now has sophisticated products and advertising machinery built to capture attention, personalise user experience, stay one step ahead of regulation and hook consumers long before they ever touch a cigarette. The tobacco and nicotine industry now markets an expanding universe of products – from heated tobacco and e-cigarettes to “aromatic nose inhalers” and nicotine pouches. Most of these products contain nicotine in different forms and concentrations, flavours and all of them exploit desire, reward pathways and the psychological hooks of habit and dependence. If, in the last century, cigarettes were marketed by images of rugged masculinity and reassuring doctors, today’s new generation of tobacco and nicotine products is packaged in joyful, playful social media posts attuned to millennials, Gen Z and younger audiences. There is bright packaging, unboxing videos, or lifestyle clips that blur the line between advertising and entertainment. Many play along, click, like and share. New products are being designed to attract children and young adolescents, mimicking candies and toys. The strategy remains the same: to make nicotine and tobacco products look modern, harmless, and desirable. Much of this content is not presented as advertising at all. The addictive architecture of social media does the heavy lifting. Influencers trusted by millions of young followers may feature these products under the guise of authentic personal recommendations, while in reality contributing to the industry’s transnational marketing reach. Viral ads multiplied by trust is a very powerful combination that does much harm in the wrong hands. This concerns me personally. As a father of two daughters, I can see how important social media is for them. It gives the feeling of emotional connection, belonging, and significance. And this is true for me as well – I can feel social media influencing my worldview and my work at WHO/ Europe every day. Full implementation of Framework Convention on Tobacco Control One of the most striking findings in the WHO/ Europe report is that the most powerful tobacco-control measures are already known and proven to work, but their adoption and proper implementation at country-level is lacking. Since 2019, rates of adolescent e-cigarette use have increased in 22 of 25 EU countries reviewed, and in all of them, girls report higher use than boys. Tobacco use among women in the EU remains high and sharply contrasts with the global downward trend. This is in line with the findings of the European Commission’s latest evaluation of the EU tobacco control framework, which highlights the rapid rise of novel tobacco and nicotine products — especially among young people — as a key and growing challenge. All of this points to one conclusion: full implementation of the WHO FCTC is overdue. The EU’s existing directives – the Tobacco Products Directive, the Tobacco Advertising Directive, and the Tobacco Taxation Directive – must be updated and strengthened to deliver on the treaty’s commitments . Today’s major problems include uneven implementation, regulatory loopholes, and slow adaptation to new products and new realities of digital marketing –all influenced by the tobacco industry. A strong political commitment is necessary to overcome these challenges and change the trajectory of nicotine and tobacco use. Europe can lead once again By accelerating implementation, closing regulatory loopholes, modernizing legislative frameworks to address digital marketing, and applying effective price and tax measures, the EU can set a powerful global example and advance the vision of a Tobacco-Free Generation by 2040, an ambition set out in Europe’s Beating Cancer Plan, and later re-iterated in the EU Safe Hearts Plan. Twenty years on, the FCTC continues to provide a strong foundation, but today’s market realities call for its full implementation that is complemented by forward-looking measures. As an early architect and champion of the FCTC, the EU is uniquely positioned to lead once again – and this leadership will be most effective if exercised without delay, ensuring that policy not only keeps pace with, but anticipates, emerging products and industry tactics. Hans Henri Kluge is the regional director of the WHO/European Region. Image Credits: Filter, WHO, WHO. Landmark EU Vote Demands ‘Only Yes Means Yes’ Rape Law, Targeting Gaps in Survivor Care 01/05/2026 Felix Sassmannshausen Legislators Joanna Scheuring-Wielgus and Evin Incir present the parliament’s demand for a rape law based on an ‘only yes means yes’ principle. STRASBOURG – Amid a global backlash against sexual and reproductive rights, the European Parliament has taken a decisive stand by voting for a unified, human rights-based standard for sexual offences. This Europe-wide legislative push aims to overhaul the fragmented national laws that currently leave many survivors without access to justice or essential health support. The resolution formally urges the European Commission to draft binding laws that recognise rape is fundamentally defined by a lack of consent. This represents a stark departure from outdated national models that require victims to physically fight back or explicitly say no. Swedish lawmaker Evin Incir addresses the European Parliament. “It is both morally and legally unacceptable that women are not protected by ‘only yes means yes’ legislation across the EU,” leading lawmaker Evin Incir from the centre-left social democrats (S&D) declared following the plenary vote on Tuesday. Just hours earlier, the European Parliament had adopted a landmark report with 447 votes in favour, 160 votes against, and 43 abstentions, demanding a unified standard for sexual offences. The push for reform is driven by a societal reckoning, spurred by cases that have sparked international outrage, such as that of Gisèle Pelicot in France. During a high-profile 2024 trial, the public learned that Pelicot’s husband had covertly drugged and raped her over a decade, also inviting dozens of men to rape her while she was unconscious. Human rights baseline: only yes means yes Comparison between outdated force-based legal requirements and the Parliament’s proposed standard of affirmative, voluntary consent. At the core of the European debate is the push for an ‘only yes means yes’ principle to ensure that any sexual act without freely given consent is legally classified as a crime. While a clear verbal “yes” is the most direct method, legal experts emphasise that consent can be expressed in any voluntary and unambiguous way, meaning affirmative gestures or reciprocal actions, depending on the specific context of the relationship. Establishing legislation focused on the lack of consent is widely viewed as the necessary next step to implement the Istanbul Convention. Opened for signature in 2011 and ratified or acceded to by 39 parties, Article 36 of this comprehensive international treaty explicitly requires member states to criminalise all non-consensual sexual acts, setting a clear human rights baseline. A unified legal definition is essential for health policy, as it directly impacts how survivors access emergency contraception, trauma counselling, and forensic medical care. Recognising the health sector’s critical role in this recovery process, the WHO Regional Office for Europe provides health system baseline assessments to help stakeholders monitor member states’ compliance with the Istanbul Convention. The latest comprehensive EU gender-based violence survey reveals that a staggering 30.7% of women across the bloc have experienced physical or sexual violence, which aligns with global data. Crucially, 8.4% of women report being raped while under coercion or being unable to refuse, nearly double the 4.8% who experienced overt physical force. Despite this high prevalence, systemic barriers continue to suppress official reporting and hinder access to post-rape care. Only 13.9% of victims ever contact the police, frequently citing embarrassment, fear of retaliation, or a belief that law enforcement cannot help them as their primary reasons for silence. Acknowledging trauma and fear responses Neurobiological evidence from the Karolinska Institute shows 70% of survivors experience paralysis, supporting calls for an ‘only yes means yes’ approach. A critical aspect of focusing on the lack of consent involves officially recognising the physiological realities of trauma. Medical experts and victim advocates continuously stress that a lack of physical resistance does not equate to a voluntary agreement. Co-rapporteur Joanna Scheuring-Wielgus during the plenary debate. Legislators underscored the neurobiological “freeze” response, where a victim perceives overwhelming danger, and the body is rendered completely paralysed. “It’s important to understand that a victim may not always have the strength to fight, to say no,” Polish co-rapporteur Joanna Scheuring-Wielgus explained at the press conference. While some victims might actively fight back, others can also freeze or faint. A 2017 Swedish study from the Karolinska Institute found that 70% of sexual assault survivors experience significant “tonic immobility,” an involuntary, temporary state of motor inhibition triggered by intense fear. Current legal systems in several member states routinely dismiss cases where victims experienced this involuntary physiological paralysis, which the European Parliament notes causes severe secondary victimisation. Furthermore, victim support networks like Women Against Violence in Europe (WAVE) warn that failing to provide trauma-informed, gender-specific responses deters survivors from seeking essential medical and psychological support. Implementing laws based on an ‘only yes means yes’ principle would mandate that judges and law enforcement officials understand these complex trauma responses. Policy analysts argue this shift is vital for building trust in public institutions and ensuring that victims feel safe enough to access specialised healthcare services. Fractured legal landscape leaves survivors vulnerable German legal barriers create a stark gap between rising rape reports and actual criminal convictions. The contrast between different national models highlights why European lawmakers are demanding unified rules. In Germany, the current framework dictates that a victim must signal refusal, meaning perpetrators often escape conviction if the victim remains passive due to fear. According to recently published data from the Federal Criminal Police, 14,454 rapes were reported in Germany in 2025, an 8.5% increase that officials attribute primarily to a growing willingness among victims to come forward. However, the consequences of the current legal framework are still reflected in extremely low conviction rates, with the women’s rights organisation Terre des Femmes estimating that only one in one hundred rapes ultimately results in a conviction. Legal practitioners, including the German Women Lawyers Association, argue that this standard protects perpetrators rather than victims by shifting the responsibility of communication onto the assaulted person. They maintain that establishing the lack of consent as the legal threshold is the necessary next step to enable more victims to seek justice. Conversely, countries such as Sweden and Spain have recently reformed their penal codes to ensure that sexual relations must be affirmatively agreed upon. While Sweden has already recorded a subsequent rise in convictions due to broadened evidence admissibility, monitors note that Spain’s groundbreaking 2022 law has yet to translate into similar statistical increases. Political tide is changing in Europe After tough negotiations, the European Parliament voted for a unified legal standard based on an ‘only yes means yes’ principle on Tuesday. The road to a unified standard has been fraught with conflict. During the 2024 negotiations for the EU’s first Directive on violence against women, a blocking minority led by France, Germany, and Hungary successfully stripped rape from the final text. Rapporteur Evin Incir reminded the public of the “unholy alliance” of leaders – including Viktor Orbán and Emmanuel Macron – who formed this blocking minority. These national leaders had argued that the European Union lacked the legal competence to harmonise criminal laws on sexual violence. Only US Votes Against Women’s Rights Document at UN Commission However, the political winds are shifting. Mounting public pressure has forced national governments to reconsider, with countries like France now actively revising their own criminal codes to align with an ‘only yes means yes’-based model. Despite the momentum, the proposal faces fierce opposition from far-right factions who frame the initiative as an ideological overreach. During the Strasbourg debate, an MEP from the Patriots for Europe group argued that “human relationships do not unfold through formalized steps or legal checklists,” claiming the law would amount to morally policing intimate desire. Other right-wing voices attempted to pivot the debate toward anti-immigrant narratives, suggesting lawmakers should “protect the streets, not the bedrooms”. Progressive lawmakers swiftly rejected this framing, citing data that proves the vast majority of sexual assaults are committed by perpetrators known to the victim, underscoring the systemic, domestic nature of the crisis. More than judicial reform needed The proposed European standard combines legal reform with mandatory education and trauma-informed training for law enforcement. Establishing the ‘only yes means yes’ principle as the legal threshold for rape demands a fundamental re-evaluation of how European societies view sexual availability and interpersonal power dynamics. The core premise is that sexual partners must actively communicate their desires and mutually negotiate the boundaries of their intimacy. However, reforming the penal code to reflect the lack of consent is only one part of the broader societal transformation envisioned by the European Parliament. Lawmakers are heavily emphasising the need for mandatory, comprehensive sexuality and relationship education across all member states. To ensure these legal reforms are effectively applied, parliamentarians are also demanding mandatory, trauma-sensitive education for law enforcement officers to prevent secondary victimisation during police investigations. “Why in 2026 should it be controversial that we demand that it should be mandatory for those who are working to support these women and girls who are victims?” rapporteur Incir asked, pointing to the tough negotiations with conservative co-legislators. The European Commission has signalled its readiness to support this cultural shift by mapping the current legal landscape across the Union to identify further legislative action. However, it could take years before an EU-wide law takes effect: after the Commission proposes a legal framework, the parliament and EU member states have to negotiate their positions and find a compromise. Image Credits: Felix Sassmannshausen/HPW. Energy Transition ‘Past Point of No Return,’ 57 Nations Declare at First Fossil Fuel Phase-Out Summit 01/05/2026 Stefan Anderson Coalition launches first sustained diplomatic push to phase out oil, gas and coal as war in the Middle East exposes the costs of fossil fuel dependence. The first international conference on phasing out the oil, gas and coal igniting the climate crisis ended with 57 governments representing every continent and a third of the global economy declaring the transition away from fossil fuels is now irreversible. “Actions taken to date prove that the energy transition is past its point of no return,” the coalition declared in its closing document, affirming all members were “ready to advance their transition away from fossil fuels.” The momentum is partly driven by concern for the planet, but also by a strategic desire for the energy independence that renewables could provide in an era of geopolitical instability – a case sharpened by the havoc the war in the Middle East was wreaking on the global economy as delegates gathered on Colombia’s Caribbean coast. “In a time that has been marked by fragmentation, that has been affected by war, by mistrust and the climate crisis, to sit here together and talk about the challenges, talk about the taboos, it’s a deep transformation of policy,” Irene Vélez Torres, Colombia’s environment minister and conference co-chair, said in her closing remarks in Santa Marta. Conference co-chairs Irene Vélez Torres, Colombia’s environment minister, and Stientje van Veldhoven, the Dutch climate minister, celebrate at the closing plenary. “When they look back at us from the future, they will remember that we were there, working on the challenges of our time,” Vélez Torres added. “That we decided not to focus on an economy built on war and destruction — we decided instead that it was necessary to prioritise life, security, certainty, sovereignty and solidarity.” The conference produced no binding commitments, no finance pledges, no promises of emissions cuts — that wasn’t the point. Instead, organisers pitched the summit as a “safe space” for countries already committed to phasing out fossil fuels to speak frankly. No negotiations, no consensus text to be watered down, no red lines passed down from governments to throw a wrench into discussions. A space free of the fossil fuel lobbyists who fill the corridors of UN climate summits by the thousands, both openly and embedded in petrostate delegations, often outnumbering full national delegation teams. “The fact we didn’t have negotiations here makes for such a different dynamic,” said Stientje van Veldhoven, the Dutch climate minister and co-chair alongside Vélez Torres. “The psychology of the Santa Marta process is something that we will definitely make sure to carry forward.” A coalition born of frustration Two weeks of negotiations in Belém, Brazil, failed to address a phase-out plan for coal, oil and gas as more than 100 nations blocked language on the fossil fuels at the root of the climate crisis. Three years on from the COP28 breakthrough in Dubai, where nearly 200 countries agreed to “transition away from fossil fuels,” efforts to translate the pledge into concrete action have hit a wall. Negotiations to agree a phase-out roadmap at COP30 in Brazil last November were torpedoed by a coalition of petrostates led by Saudi Arabia, which drew over half of the nations in attendance to its side in opposing the plan. The final text in Belém contained no reference to “fossil fuels” at all, a marked step backwards for the UN climate process. Without that failure, the Santa Marta conference would not exist. Conceived in the hours after COP30 collapsed, the new process was born of frustration with the gridlock of consensus-based UN climate diplomacy. But its architects stressed that it is meant to be complementary to mainstream COPs, not to replace them. “It’s very important that we agree on the fact that we want this conference, this process, to be like an accelerator for what we want to do in the context of UNFCCC,” van Veldhoven said, adding that the chairs have already been in touch with the COP31 presidency. Alongside government ministers, the conference included nearly 3,000 representatives of subnational governments, trade unions, scientists, civil society groups, Indigenous Peoples, women’s organisations and youth representatives, all named in the closing document as equal participants rather than observers, the title they hold in UN negotiations. “A new reality is taking shape: this is no longer a one-off moment, but the foundation of an ongoing international process dedicated to phasing out fossil fuels,” said Kumi Naidoo, president of the Fossil Fuel Treaty Initiative. “What is emerging is a process that can finally match climate diplomacy to the scale of the crisis.” Countries will attempt to carry the momentum forward at the next phase-out conference, confirmed in the closing hours to be held in 2027 on the Pacific island of Tuvalu and co-hosted by Ireland, pairing a wealthy European island with one across the globe at risk of disappearing under sea-level rise. “We are making history. We have proven, in the words of our youth, that another way is possible,” Tuvalu’s representative said. “The world is in a fossil fuel crisis, of climate breakdown, of conflict, of instability. But here in Santa Marta, we have planted a seed of solutions.” The tailwind from Hormuz Roughly a fifth of the world’s oil passes through the Strait of Hormuz, where wartime disruptions have driven prices to their highest level in years and exposed how much the global economy still depends on fossil fuels. Running through the conference was the war between Israel, the United States and Iran, which has disrupted shipping through the Strait of Hormuz, tightening gas supplies across Europe and Asia and skyrocketing oil prices to their highest level in years. On the same day delegates closed proceedings, US President Donald Trump told reporters Iran would have to “cry uncle” before he lifted what he called his “genius” blockade. Brent crude hit $126 a barrel hours later, approaching the spike that followed Russia’s invasion of Ukraine in 2022. For the three-quarters of the world that depends on fossil fuel imports, the message of the past five days was hard to miss: their energy costs, inflation rates, fiscal stability and the prices their citizens pay for food and fuel are tied to decisions made by a handful of leaders in Washington, Moscow and Riyadh – none of whom were in Santa Marta. The coalition’s closing document named the Hormuz crisis directly, calling the disruptions a demonstration “that reducing fossil fuel dependencies is critical” to “keep our planet livable, to safeguard energy security, and to build economic resilience to volatile fossil fuel markets.” “Destructive oil wars, widening fuel and food shocks, and a mounting climate crisis only bolster the conviction that breaking free from the fossil fuel system is not a matter of magical realism but of radical realism, in line with science and the law,” said Nikki Reisch, director of climate and energy at the Centre for International Environmental Law. Van Veldhoven framed the crisis as part of the case for moving faster. “If these countries significantly reduce their dependency on fossil fuels, it means they’ll be investing in their own economy instead of importing fossil fuels from abroad,” she told Bloomberg. “It means they’ll be investing in clean technologies, but it also means they’ll be shielding their economies against the kind of price shocks we’re seeing currently.” Santa Marta: Key outcomes from first summit on ‘transitioning away’ from fossil fuels | @daisydunnesci Read here: https://t.co/YGUgQR5BTg pic.twitter.com/1nZuILSPO7 — Carbon Brief (@CarbonBrief) May 1, 2026 France became the first major economy to act on that argument at scale during the conference, releasing a national roadmap to eliminate fossil fuels from its energy mix by 2050. The plan does not introduce new pledges but consolidates existing French climate and energy targets under a single explicit goal: ending the use of oil, gas and coal for energy purposes by 2050. Globally, the picture is mixed. Fossil fuels remain responsible for more than 75% of greenhouse gas emissions, but new renewable capacity in 2025 is nearly 50% higher than in 2023, and renewables are meeting nearly all new energy demand, according to the International Energy Agency. Investment in the energy transition reached a record $2.4 trillion in 2024, more than double 2019 levels, though it is concentrated in advanced economies and China, IRENA found. “This momentum is not yet enough to deliver the needed breakthrough,” said Bronwen Tucker, public finance lead at Oil Change International. “The richest polluting countries must take immediate action to accelerate their transitions at home and show up with meaningful international economic cooperation.” Coalition of the self-aware For all its ambition, the coalition openly admitted the limits of its own reach. The outcome document released in Santa Marta lays out in candid detail the shortcomings of the coalition in Colombia, and the distance all nations still have to go to achieve the transition away from fossil fuels. Chief among these admissions is the degree to which most nations in attendance continue to be dependent on oil, gas or coal for the public revenues that fund health, infrastructure and other government functions, and ensure energy security. Until governments find a way to replace that funding, walking away from fossil fuel production remains off the table. “The countries present in Santa Marta still have structural dependencies to overcome, including fiscal dependencies, debt constraints, the dependence of the financial architecture on fossil fuels,” the outcome paper states. “Transitioning away from fossil fuels is more than replacing one energy source with another … the transition itself is complex.” Many others simply do not have the financial headroom to invest in renewables due to looming debt payments and empty balance sheets. “We must confront economic dependence on fossil fuels that shape the realities we face,” Tuvalu’s delegate said. “Unsustainable debt, reliance on fossil fuel revenues, and a global financial system that was not built for us, and too often fails us.” The coalition also recognised the limits of its own power. While the alliance contains a meaningful contingent of major fossil fuel producers – Norway, Canada, Australia, the United Kingdom, Brazil, Mexico, Nigeria, Angola and Colombia itself – what it does not contain is a critical mass of global fossil fuel supply or demand. The 57 countries present make up about a fifth of global fossil fuel production, a third of oil and gas demand, and the same share of world economic output. The five biggest fossil fuel producers – the United States, China, Russia, India and Saudi Arabia – were all absent. Together, they control nearly half the world economy, and pump about 45% of the world’s oil, half its natural gas and three-quarters of its coal, far outstripping the heft of the Santa Marta coalition on all fronts. “We are here with an immense group, and yet it is still too small a group for what our ambition actually is,” van Veldhoven said. “Let’s make sure that we continue to drive this process as an open coalition. That means we have to ensure visibility of the outcomes and use that as an invitation to others to join us.” Rockstars to the rescue Attendees gather for the launch of the Science Panel for the Global Energy Transition (SPGET) in Santa Marta. A concrete outcome of the summit is the creation of a new scientific panel to advise nations on the practice and policy of the fossil fuel phase-out, an idea born in the halls of COP30, which Vélez Torres pitched as a sort of climate scientists’ Avengers team of “rock star academics”. “This panel not only repairs a historical debt of an organisation dedicated, finally and for the first time, to overcoming fossil fuels in the energy matrix,” she said, “it will also tell us about other types of challenges regarding the social and economic limitations of being able to carry out this transition as quickly as possible.” The Science Panel for the Global Energy Transition (SPGET) will unite over 100 scientists and academics to guide nations in policymaking and emissions pathway analysis with the goal of keeping the 1.5°C warming target enshrined in the Paris Agreement alive. The independent panel will focus on mapping policy options, green technologies and financial mechanisms that can be harnessed by countries to reduce emissions and fossil fuel dependence. Johan Rockström, director of the Potsdam Institute for Climate Impact Research and co-lead of SPGET, said it will operate as a “scientific service” to governments, helping them figure out the balance of energy supply and demand with a “scientifically aligned, just and orderly phase out of fossil fuels.” “[The panel] will also enable us to have feedback into the COP process so that we can keep the fossil fuel phase-out discussions in plenary at the COP meeting alive,” Rockström said. “Now is the moment to tip the scales, to not allow anymore that a few actors at the COP meetings always block the most important discussion of them all: the phase-out of coal, oil and gas.” The hard the work begins Delegates arrive for high-level ministerial sessions in Santa Marta, Colombia. The final agreement struck at Santa Marta establishes three “workstreams”: working groups of countries, experts and civil society that will meet between now and the next conference to develop policy options on the thorniest questions of the phase-out. The first will focus on national emissions roadmaps, taking specific aim at what Vélez Torres called the “punto ciego,” or blind spot, in the Paris Agreement: exported emissions. Under the Nationally Determined Contributions (NDCs) mandated in the Paris Accords, countries report emissions on a territorial basis, but not the emissions from fossil fuels they extract and sell to other countries. For major exporters, the effect on emissions calculations is enormous. Norway’s exported emissions from oil and gas are roughly ten times its territorial emissions. Saudi Arabia’s full emissions footprint rises to two and a half times its reported emissions, closing in on 5% of global CO2 on its own. “We are not making clear commitments about how we are going to control the emissions that are exported from producing countries,” said Vélez Torres, whose country, Colombia, sees its emissions more than double when its coal and oil exports are counted. “We want to be very clear, very honest about how to transition away from production as well.” Winding down production is one of the most complex questions in the phase-out debate. If demand falls first, producer countries face collapsing revenues and an economic crisis. If supply falls first, importers face energy shortages. A complementary workstream announced in Santa Marta, backed by the OECD, will look at how exporters and importers can coordinate their wind-downs so the two declines move in step, avoiding a scenario where one side pulls back faster than the other, leaving producers without buyers or importers without fuel before clean alternatives can fill the gap. Money traps, and future hopes Indigenous Peoples’ representatives played a central role in the Santa Marta phase-out talks. The final workstream, supported by the International Institute for Sustainable Development, takes on what the co-hosts called the three “traps” holding states back from moving faster on fossil fuel phase-outs: finance, debt and subsidies. It is, in many ways, the hardest of the three. Without alternative revenues lined up, governments cannot turn off the tap on production that pays their bills. The constraint tightens further as interest payments squeeze public budgets and credit ratings for developing nations render borrowing exceedingly expensive, leaving fossil fuel revenue indispensable and crowding out renewables investment. Then there are the subsidies. Governments worldwide handed roughly $1.3 trillion in direct support to fossil fuel producers and consumers in 2022 to keep pump and power prices low, according to the IMF, and as much as $7 trillion once the unpriced costs of pollution and climate damage are factored in. The direct figure alone is more than half the $2.4 trillion the world invested in the entire energy transition the same year, tilting the market against cheaper renewables as subsidies keep expensive fossil fuels price-competitive. In Ghana, the financial realities of fossil fuel dependence remain too steep to overcome, its delegate told the conference, despite the country supporting the phase-out goal. “In Ghana, fossil fuels remain deeply tied to government revenues that fund essential public services and to our broader energy systems,” he said. “We need a fossil fuel treaty that creates the necessary architecture for a just transition.” Ten-year-old Paula Pedro from Colombia speaks at the closing of the Santa Marta conference. That the coalition is willing to talk openly about the financial dependency at the heart of the phase-out is, for many participants, the most encouraging signal to come out of Santa Marta. Whether it can build bridges and expand its membership as the climate crisis accelerates is the question that will loom over COP31 in Antalya later this year, and in the run-up to Tuvalu in 2027. With the workstreams set and the next conference scheduled, it fell to a 10-year-old from Colombia to remind the room what the diplomacy was for. “Of the 12 million children we have in Colombia, eight out of ten of us are affected by fossil fuels and weather changes,” Paula Pedro, representing the Colombian children and youth coalition, told the assembly. “What we need, for the children, is that the people in this room do the math, but not only on paper, but accomplish change as a matter of fact.” “We’re not only the future,” Pedro said. “We are the present and beyond.” Image Credits: Colombian Environment Ministry, Colombian Environment Ministry, COP30, ColomColombian Environment Ministrybian Ministry o, Colombian Environment Ministry, Colombian Environment Ministry, Colombian Environment Ministry. Heartbroken Families Face Huge Structural Barriers When Trying to Prove Medical Negligence in India 01/05/2026 Arsalan Bukhari & Naila Tabassum Indian families face a huge struggle to get timely access to medical records of loved ones who have died in Indian health facilities, while the police can only lay a charge against a doctor if an independent medical expert first confirms negligence. NEW DELHI – India faces thousands of medical negligence cases every year, but structural problems make it extremely difficult for patients’ families to find out what has happened to their loved ones – let alone win compensation when treatment has been botched. “A shadow of death is looming over us,” Ashwini Bajaj, a Haryana-based businessman, told Health Policy Watch, recalling the treatment of his 24-year-old son, Deshbandhu, more than a year after his death. In December 2024, Deshbandhu, an MBA student at Punjab University and Bajaj’s only son, developed a fever that lasted more than two days. On 26 December, he visited a hospital near his university in Chandigarh, where he was prescribed medicines and given a series of tests, including a liver function test (LFT). By the time the results came out later that evening, Deshbandhu had returned to his parents’ home in Hisar, around 200 kilometres away. The next day, he went to a private hospital there, but his condition deteriorated rapidly. His oxygen saturation dropped to 65%, and doctors warned of acute liver failure. “We were told his condition was very critical and that the hospital did not have the resources to treat him,” Bajaj said. “We were asked to take him to a super-speciality hospital. It felt as if the ground beneath our feet had slipped away.” Deshbandhu was shifted to a major private hospital in Gurugram. “My son was there for over three weeks. His condition kept deteriorating. He went with jaundice, and he developed intestinal obstruction, kidney stress, and pneumonia,” Bajaj said. A few days after his 24th birthday, which was on 20 January 2025, Deshbandhu died. Bajaj says he has been unable to return to work. His case reflects broader systemic gaps in India’s healthcare system, where delays in critical care, weak referral systems, and limited transparency can have life-threatening consequences — and the lack of updated national data continues to hamper accountability. Transparency in treatment Deshbandhu Bajaj (24), a mountaineer and an MBA student who died in January 2025. His father, Ashwini Bajaj, alleges medical negligence. “Initially, I thought the doctors tried hard to save my child, but when I obtained all the medical reports, which took three to four months to obtain, I realised much time was lost before the actual treatment started,” Bajaj said. “When I made a day-by-day chart, I realised that, for at least four days, my son didn’t get the treatment he should have. “Every evening, I used to get payment requests promptly on my WhatsApp. If they could send payment requests, why can’t they share procedural updates the same way?” Rujhan Dhawan, a lawyer at the Punjab and Haryana High Court, told Health Policy Watch such opacity is a major barrier to accountability. “A patient, once admitted, is entirely dependent on the institution not only for treatment but also for truthful disclosure,” he said. “Critical information about procedures and complications is often not readily accessible to families.” Bajaj’s family spent over ₹30 lakh ($33,000) on treatment. He says he is not seeking compensation, but a legal framework that mandates transparency. Not an isolated case Deshbandhu’s case is not an isolated one. According to the 18th Annual MedLegal Review, 65,000 medical negligence cases were filed in India in 2025 alone. Radha Sharma (49), a resident of Rajasthan’s capital city Jaipur, died days after being given a TB drugs although she had been diagnosed with a liver-related illness. In Jaipar, around 270 kilometres from Gurugram, 55-year-old tax consultant Kishan Kumar Sharma is fighting a case linked to the death of his wife, Radha. On 3 March 2025, she developed mild jaundice and was admitted to a private hospital. A test suggested Budd-Chiari syndrome, a rare liver disorder. However, despite a negative tuberculosis test, Radha was prescribed the TB drug, Isoniazid, said Sharma. Isoniazid should not be prescribed to patients with liver disease who have bilirubin levels over 4 mg/dL, according to World Health Organization (WHO) guidelines. But Sharma says his wife’s liver disorder was overlooked. Radha’s condition deteriorated rapidly, and she died on 18 March. “I have a simple question,” Sharma said. “Why was my wife given Isoniazid? Was it part of any established protocol or something else?” The risks highlighted by such cases reflect a broader global problem. According to the WHO, an estimated 138 million patients are harmed every year due to unsafe medical care. Lack of dedicated investigative body Nishant Bharihoke, an advocate at the Delhi High Court who specialises in medical negligence cases, told Health Policy Watch the core issue lies in the absence of a dedicated independent investigative framework. “India does not have a dedicated body specifically tasked with investigating deaths or serious injuries caused by medical negligence,” he said. “When a patient dies, and the family suspects wrongdoing, there is no authority whose sole function is to find out what happened.” Complaints are typically routed through State Medical Councils, which may form inquiry committees. Their decisions can be appealed to the National Medical Commission, but Bharihoke argues that the system is structurally limited. “The National Medical Commission’s primary mandate is to regulate medical education. Its disciplinary board has no independent investigators and no power to enter hospitals and examine evidence,” he said. He also pointed to a legal loophole: since these proceedings are not strictly judicial, false statements made before such bodies do not result in perjury charges. For families like Bajaj’s and Sharma’s, he said, this gap deepens the sense of injustice. When cases turn criminal Simran Chhabra (21), a resident of Gurugram and MA student at Amity University, was suffering from a simple cough and cold. She died within minutes of being administered an intravenous injection. The family is fighting a medical negligence case in a Gurugram court. The gap becomes even wider when negligence overlaps with criminal allegations. One such case is the death of 21-year-old Simran Chhabra. On 21 January 2023, she visited a private hospital in Gurugram with symptoms of cough and cold. According to a prescription her brother, Sourabh Chhabra, shared with Health Policy Watch, she was administered an intravenous injection of Dynapar. This is usually used to treat pain and inflammation associated with arthritis or after surgery. “As soon as the injection was fully administered, Simran collapsed on the bed and froth began coming out of her mouth,” Sourabh said. “Everything happened within minutes. I had no time to understand what was going on.” She was referred to another hospital, where she was declared dead. According to Bharihoke, the family’s legal representative, the doctor later claimed that multiple emergency interventions were carried out, including five additional injections and cardiopulmonary resuscitation (CPR), using drugs typically administered in cases of severe allergic reactions. However, the post-mortem report reviewed by Health Policy Watch raises questions. It records only two puncture marks on her body, and there is no mention of a cannula (an intravenous tube) being used. If multiple injections were administered, the family asks why there is no corresponding physical evidence. In this case, they argue, the medical account and post-mortem findings do not align. “Forget conviction or arrest, even registering an FIR in such cases often requires court intervention,” Bharihoke said. A FIR is a First Information Report (FIR) in Indian medical negligence cases, a formal document prepared by police under Section 154 of the Criminal Procedure Code upon receiving information about alleged criminal negligence. Absence of a legal framework Several structural barriers insulate medical health practitioners against negligence cases, according to legal experts. “In India, police usually cannot even register a case against a doctor unless an independent medical expert first confirms negligence,” Bharihoke told Health Policy Watch. “In most cases, doctors are reluctant to give such opinions, especially against their peers.” The challenge is compounded by access to evidence. Hospitals retain control over key records, case files, prescriptions, nursing notes, and CCTV footage while families often receive only partial or delayed documentation. India also lacks a statutory system guaranteeing timely access to medical records for patients and their families. There is no clear legal mandate requiring investigators to immediately secure hospital evidence. Tanvi Dubey, a Supreme Court lawyer, told Health Policy Watch the legal framework itself raises the bar for accountability. “Criminal liability in medical negligence cases is limited to gross negligence, not simple errors of judgment,” Dubey said. “This significantly narrows the scope for prosecution.” Even initiating an investigation can be delayed: “Authorities are allowed to conduct preliminary inquiries before registering a case, which often means waiting for medical opinions and slows the process.” Dubey also pointed to the continued reliance on what is known in Indian law as the “Bolam principle,” where a doctor’s actions are judged against a body of medical opinion. “This makes expert testimony central. Unless a complainant can produce strong contrary evidence, it becomes very difficult to establish negligence,” she said. While multiple legal remedies exist, including consumer courts, civil litigation, and disciplinary proceedings, Dubey noted that each comes with limitations. “Criminal prosecution is rare, civil cases are slow and evidence-heavy, and disciplinary proceedings do not always ensure compensation or thorough fact-finding,” she said. Compared with Western peers, India faces two major policy gaps in patients’ treatment: the absence of a national electronic medical record (EMR) system, and the lack of a digital system connecting labs directly to the consulting doctor. Currently, India doesn’t have a mandatory EMR policy applicable to healthcare organisations. Even today, prescriptions, clinical notes, and drug administration records are still handwritten in the majority of hospitals and almost all smaller clinics. This makes them more vulnerable to tampering, loss and destruction. The absence of a nationwide electronic medical record system adds another layer of opacity. In many facilities, records remain handwritten and vulnerable to alteration; a gap Bharihoke alleges was evident in Simran’s case. Urgent reform is necessary India’s Minister of Health Jagat Prakash Nadda. Legal experts are calling on authorities to establish an independent statutory body to investigate medical negligence. Only families with the financial means and emotional capacity to pursue long legal battles are able to take up medical negligence cases. For many others, the burden becomes too heavy to carry. While the rules may appear neutral on paper, experts say their impact is deeply unequal. Legal and policy experts argue that the most urgent reform is structural, particularly the creation of an independent statutory body tasked solely with investigating patient safety incidents, particularly in cases involving death, permanent disability, or serious injury. Such a body should have the authority to enter hospital premises, access medical records, secure CCTV footage, and record statements. Its findings should be made public, while the evidence it collects remains protected from use in criminal or disciplinary proceedings. In England, the Health Services Safety Investigations Body (HSSIB), established in 2023, follows this approach by conducting independent investigations into patient safety incidents. Globally, different systems offer alternative approaches to accountability. In the United States, oversight is spread across multiple layers: state medical boards regulate conduct, a national database tracks malpractice records, hospitals report serious incidents, and patients can pursue civil litigation. China follows a three-tier system, allowing patients to first negotiate with hospitals, then seek mediation, and finally pursue civil lawsuits. In parts of Europe, including France and the Nordic countries, no-fault compensation systems allow patients to receive compensation without proving negligence, making the process more accessible and less adversarial. Aviation and rail safety investigations have long operated on similar principles, focusing on systemic failures rather than individual blame. For India, experts say the lesson is clear. Accountability frameworks do not have to rely solely on litigation. A system built on independent investigation, timely access to evidence, and patient-centric redress could help provide answers to families like the Bajajs and Sharmas. Image Credits: César Badilla Miranda/ Unsplash, Felix Sassmannshausen. No Pandemic Agreement Annex by World Health Assembly, Says Civil Society 30/04/2026 Kerry Cullinan (Left to right from top) Third World Network’s moderator and speakers Lauren Paremoer, KP Gopakumar and Tamara Prisenburg form AIDS Healthcare Foundation. The final missing piece of the Pandemic Agreement – a pathogen access and benefit-sharing (PABS) system – is unlikely to be agreed on by the World Health Assembly (WHA) later this month. This was the view of civil society observers of the talks taking place at the World Health Organisation (WHO) headquarters in Geneva, who briefed the media on Thursday. The sixth round of talks is scheduled to end late on Friday night (1 May). Earlier in the week, WHO Director General Dr Tedros Adhanom Ghebreyesus told a Geneva media briefing that “key differences remain on key issues”. “I still see a common will to reach consensus, which means I continue to believe there is a way to reach consensus,” Tedros added. Although the notion of a “hybrid” PABS system is being discussed informally, its proponent, the European Union (EU), has not presented any formal text, Third World Network’s (TWN) KM Gopakumar told the media briefing, which was hosted by TWN and the AIDS Healthcare Foundation. While Brazil and Botswana have apparently indicated that they might support a hybrid or “blended” compromise, the Africa Group is opposed to it, according to the civil society representatives. WHO member states are negotiating how to share both information about dangerous pathogens and some of the “benefits” that manufacturers may develop from that information – namely, vaccines, therapeutics and diagnostics (VTDs). The “hybrid” or “blended” proposal is a mix of mandatory and voluntary measures for sharing pathogen information and any benefits that flow from this information. It de-links information-sharing and benefit-sharing. Gopakumar said that, in terms of the blended agreements, countries that shared pathogens “will have the freedom to choose to attach certain conditions for sharing the data and the sample, including benefit sharing requirements” or share without any conditions. Kill the efficiency Shifting the choice to individual countries would undermine the efficiency of a single PABS system as users would need to negotiate with the individual countries instead of through a centralised system, he argued. “If you have a hybrid system, first of all, it kills the efficiency [of a single system], and second, it’s going to debase the access and benefit sharing norms set by the international instruments like the Convention on Biological Diversity and the Nagoya Protocol. Any attempt to dilute benefit-sharing obligations would be a “disaster” for equity, said AHF’s Tamara Prisenberg. Lauren Paremoer of the People’s Health Movement said that the blended model introduces “a two-track system for accessing pathogens” that violates access and benefit-sharing on an “equal footing” specified in Article 12 of the Pandemic Agreement. One track would allow anonymous users to access pathogen data without upfront commitments to benefit-sharing or legally binding contracts. The other was in line with Article 12, permitting access to pathogens through databases and laboratories that would require users to register and commit to specified benefit-sharing. Earlier in the day, the Intergovernmental Working Group (IGWG) briefed civil society on text-based negotiations, but very little of the text they shared had been “greened” to show agreement. EXCLUSIVE: WHO Opens Nominations for Next Director General; Germany May Advance Former Merkel Aide, Helge Braun 30/04/2026 Felix Sassmannshausen, Elaine Ruth Fletcher & Editorial team WHO DG Dr Tedros Adhanom Ghebreyesus issued a call for nominations for the DG elections. He recently travelled to Berlin, where he met with high-level politicians and the WHO’s Pandemic Intelligence team. As the World Health Organization (WHO) formally opens the nomination process for the next Director-General, Germany now appears likely to propose Helge Braun, Chief of Staff in former Chancellor Angela Merkel’s government, according to Berlin insiders. But after slashing its global health budget, sources question whether a German candidate can win wide support from other WHO member states. WHO Director-General Dr Tedros Adhanom Ghebreyesus has formally issued a call to WHO member states for nominations to the DG elections, scheduled for May 2027, in an invitation sent on 24 April to all WHO member states. WHO confirmed this in an email to Health Policy Watch. The invitations had been sent via private letters to countries’ Geneva missions. The period in which member states may nominate candidates will now run for six months, until 24 September. Contenders who have until now remained in the shadows are expected to begin coming forward publicly with their candidacies at the World Health Assembly in May. From the German perspective, Berlin wants its financial weight reflected in executive influence at the multilateral level as the largest global health donor following the US withdrawal from the WHO in January 2025. The withdrawal, combined with the US non-payment of dues owed, thrust WHO into a budget crisis, prompting layoffs of about 25% of the workforce in the past year. German Foreign Ministry neither confirms nor denies The German Foreign Ministry, formally responsible for the nomination, declined to confirm or comment on Braun’s potential candidacy when responding to a query by Health Policy Watch. Germany’s other potential candidates include the contested former Health Minister Karl Lauterbach and the lesser-known Paul Zubeil. In contrast, Braun’s dual profile as an accomplished politician, skilled financial manager, and trained physician and researcher who successfully built cross-party bridges offers a distinct advantage. But he is little known outside of Germany. Bridge-builder with executive and medical expertise Former Chair of the influential German Budget Committee, Helge Braun (right), and former French Chair of the Finance Committee, Claude Raynal (left), in the Bundestag. The current WHO leadership landscape demands a candidate capable of managing deep institutional fractures and uniting a divided global community. Despite him being largely unknown in the international community, Germany could be expected to emphasise Braun’s extensive fiscal and crisis management experience in any candidacy it mounts. As ‘Head of the Chancellery’, effectively Chief of Staff, in Angela Merkel’s last term as Chancellor, from 2018 to 2021, Braun operated at the nexus of scientific advice and political implementation during the COVID-19 pandemic, notably comparing the Chancellery to an intensive care unit where acute problems must be solved. Between 2021 and 2025, Braun then chaired the powerful Budget Committee of the German Bundestag (Parliament), overseeing the distribution and management of hundreds of billions of Euros with strict discipline This profound understanding of macroeconomic management, coupled with his pragmatic defence of Germany’s controversial debt ceiling alongside crisis-driven special funds, makes him an attractive prospect for donor nations currently demanding more financial accountability and restructuring at WHO in Geneva. Serving as a central mediator across government ministries, Braun built a reputation as a highly pragmatic problem solver whose past domestic political affiliations will not necessarily dictate his future approach to global health governance. This pragmatism complements his longstanding political advocacy for research into infectious diseases like Ebola and malaria. And unlike many career politicians, Braun’s foundational expertise lies in medicine, having worked for years as an intensive care physician and anaesthesiologist. He returned to these roots in April 2025 by assuming the presidency of the University of Lübeck, an institution renowned for its focus on life sciences and artificial intelligence. Why the candidacy might spark concerns WHO member states are currently negotiating a pathogen access and benefit-sharing (PABS) system in Geneva. While Braun championed early interventions and massive digitisation projects in his role as Merkel’s Head of the Chancellery during the COVID pandemic, severe bureaucratic delays hampered the rollout of vaccination campaigns and testing strategies. This tarnished his crisis management legacy just as he exited the federal government. His domestic political capital suffered further damage during the December 2021 Christian Democratic Union leadership election, where he lost heavily to conservative rival Friedrich Merz, now Chancellor. Party members largely rejected Braun as an establishment candidate, perceiving him as too closely aligned with the moderate legacy of former Chancellor Angela Merkel. Additionally, it is questionable whether Braun would wield the necessary diplomatic connections and familiarity with foreign health systems to be effective on Day One of a term as WHO head. The Director-General must immediately command trust and authority on the international stage, particularly when dealing with health ministries and stakeholders in the Global South. Most notably, the German government opposed the release of COVID-19 vaccine patents during his tenure, drawing sharp criticism from international health equity advocates. Defending this refusal in May 2021, Braun wrote in a guest article for the German newspaper Die Zeit that “patent protection as a driver of innovation is not the problem in this crisis, but an essential foundation for its solution.” In the Global South, this track record could thus reinforce the perception that Germany defends pharmaceutical interests over equitable technology transfer – especially in the face of current PABS Annex negotiations. Recent reports from Tagesspiegel Background indicating that the former minister was approached by Germany’s Association of Research-Based Pharmaceutical Companies to become their next president, when the post becomes vacant at the end of 2026, might further fuel these concerns. Finally, Germany has been cutting back its Official Development Assistance (ODA) in general, including contributions to the World Health Organization, where it has historically been the largest member state donor after the United States. On Wednesday, the Merz government announced its 2027 budget plans with further ODA cuts following last year’s drastic 17% reductions. The likelihood of Germany fulfilling its original 2024 financial pledge to WHO for the current biennium (2026-27) also remains in doubt. “They can put forward a candidate, but I don’t think it’s going to get a lot of traction from other member states,” said one informed WHO source. “At a time when Germany is reducing global health funding to member states, I don’t think they can go ahead and claim the top seat.” Step back and support allied candidates? Braun served as Head of Chancellery under then German Chancellor Angela Merkel, seen here with WHO Director General Dr Tedros in Berlin in 2021. Furthermore, domestic opinion remains highly divided on mounting a campaign amidst the geopolitical strains on Chancellor Friedrich Merz’s coalition and Tedros has reportedly urged Germany to back allied candidates instead. At the same time, the desire to seize more leadership in the UN system remains strong after Germany’s failed previous attempt to secure the top role at the UN High Commissioner for Refugees in 2025. Currently, Germany is also pushing for another attempt at a UN Security Council seat. Should Germany put forward a candidate, Foreign Minister Johann Wadephul, who will make the final decision, also faces a stark choice between Braun and the better-known Karl Lauterbach, as well as Paul Zubeil with his strong international health and technical background. Advancing a WHO outsider like Braun against established public health veterans is a highly calculated risk for Berlin, which must first convince other European countries to rally behind him. In case Berlin formally nominates Braun, the success of his candidacy will depend entirely on how effectively the government can reframe his perceived lack of field experience and global networks as delivery on fresh, badly needed fiscal expertise and perspectives. Grappling with WHO’s funding crisis As the race for the next Director-General opens for formal nominations, the names of over a dozen high-profile potential candidates are still circulating – from Indonesia to the United Kingdom. Want to Become the Next WHO Director-General? Get in Line And the list is still growing. Among the newer names being floated is that of Dr Hanan Mohamed al-Kuwari, who served as Qatar’s Minister of Public Health until November 2024 and chaired the 153rd Session of the WHO Executive Board. Before joining the Hamad Medical Corporation in 1996, where she ultimately rose to managing director, al-Kuwari worked for Reuters and as a freelance health reporter. Holding a PhD in healthcare management from Brunel University and bringing early career experience from the WHO, she represents a highly networked voice from the Arab world, celebrated for her crisis resilience and for shaping the WHO’s recent global work programme. Dr Maria Neira, former WHO Director of Climate, Environment and Health Another candidate who has been mentioned is Spain’s Dr Maria Neira, who recently retired from WHO as the director of Climate, Environment and Health. An iconic spokesperson for the climate, environment and health movement, Neira is known as a telegenic personality and adroit politically. As a young medical doctor, she worked in emergency relief in Latin America and Africa, and later served as Spain’s Vice Minister of Health and Consumer Affairs as well as President of the Spanish Food Safety and Nutrition Agency. However, Spain also recently decided to nominate a candidate to head the UN Food and Agriculture Organization (FAO), when Qu Dongyu’s second term as Director General ends in July 2027, leaving doubts about whether it would want to mount yet another campaign, in parallel. Continuing decline in ODA and global health aid Drastic ODA cuts and reduced global health funding leave vulnerable populations in precarious conditions worldwide. Whoever is elected will have to continue grappling with the continuing long-term declines in donor-driven ODA, and particularly global health aid – directly to countries and to WHO. While WHO 2026-2027 $4.2 billion base budget is now 85% financed, according to Tedros’ comments on Wednesday, declines in ODA continue to cast uncertainty on how the remaining $630 million gap will be filled. It’s unlikely that the $260.6 million in assessed US contributions still due for years 2024-2025, before the withdrawal became official in January, will ever be repaid, conceded WHO’s Tedros at a Geneva press briefing on Wednesday. “We’re hoping to get the money, but no signals yet,” Tedros told journalists, adding: “No signals means maybe we may not be able to get the money. The likelihood could be not getting the money.” “We’re looking at nontraditional donors. We’re looking at international financial institutions and other ways to mobilize that 15%,” Tedros said, in terms of filling that gap. “It’s not that we won’t go to the traditional donors, but I think we’re expanding that donor base.” This article has been edited to reflect additional information regarding Dr Hanan Mohamed al-Kuwari’s early career as a freelance journalist. Image Credits: X/Dr Tedros, Deutscher Bundestag/Leon Kügeler, European Commission. 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Pandemic Talks Extended – But Colombia Appeals for New ‘Method’ to Settle Differences 04/05/2026 Kerry Cullinan South Africa, speaking for the Africa Group and Group for Equity. Colombia has appealed for a new “method” to settle the outstanding annex of the Pandemic Agreement, after World Health Organization (WHO) member states failed to reach agreement last week after almost a year of talks. Talks on a Pathogen Access and Benefit Sharing (PABS) system were due to wrap up last Friday night, but have since been extended to July, with a resolution in that regard being prepared for the World Health Assembly, which starts on 18 May. “There is one fundamental point that we request be included in the resolution: extending the negotiating period makes no sense unless the negotiating method is changed,” Colombian Ambassador Germán Velásquez told the Intergovernmental Working Group (IGWG) shortly before the meeting closed last Friday evening. “It is not possible to continue seeking consensus in the same way. Why not introduce the concept of ‘progressive consensus’? Once a majority has been reached on specific points, a vote should be held if necessary, and negotiations should continue.” Colombia is part of the Group for Equity, a large cross-regional alliance of countries that has been pushing for a PABS annex that ensures the inequity of the COVID-19 pandemic, where wealthy countries commandeered all the scarce vaccines, is not repeated. The proposal for voting also has the support of some civil society groups, notably Pedro Villardi, from Public Services International, a trade union federation with over 30 million members. “If we need [to reach an agreement], why don’t we vote? We have a majority of countries pushing for equitable provisions… and we have a few countries that are opposing these measures and defending the position of the pharmaceutical industry and other big corporations,” Villardi told a recent briefing on the negotiations. Increasingly frustrated The Group for Equity and the Africa Group – which represent the vast majority of member states – have become increasingly frustrated by what they see as developed countries protecting the interests of their pharmaceutical companies instead of levelling the playing field ahead of future pandemics. The PABS system is due to govern how dangerous pathogens are shared during public health emergencies and how any medical products (benefits) that accrue from this information are shared. The dispute, mainly between developed and developing countries, hinges on how countries that share pathogen information can benefit from any vaccines, therapeutics or diagnostics (VTD) developed as a result. The Group for Equity and Africa want mandatory benefit-sharing, with the terms set out in standard contracts between the WHO and pharmaceutical companies. Several European countries – notably those with powerful pharmaceutical industries – argue that compulsory benefit-sharing will stifle research and development. According to the current draft, the WHO will receive a donation of 10% of vaccines or medicines produced by pharmaceutical companies that sign up to PABS – but only during a pandemic, not a public health emergency of international concern (PHEIC). ‘Deep regret’ At the close of last week’s talks, South Africa – unusually speaking both for Africa and the Group for Equity – expressed “deep regret” that IGWG is “still far from reaching consensus on the text of the Pandemic Agreement annex”. “We have engaged constructively and in good faith, including by putting forward concrete proposals. We also considered other approaches, but found, ultimately, that these fall short of the IGWG mandate to deliver a PABS annex that preserves the principle of an equal footing between access and benefit sharing,” said South Africa. “Approaches that risk decoupling these elements, or introducing fragmentation from the outset, are not sustainable foundations for the system we are tasked to build, and may only legitimise the unfair status quo regarding access to essential health products,” added South Africa, referring to a “hybrid” proposal put forward by some European countries during informal negotiations. The two groups are “strongly united” on a PABS system that is “fair, equitable and capable of correcting long-standing imbalances, including inequitable access to VTDs and unjust extraction of our genetic resources”, said South Africa. “A credible landing zone requires legal certainty at a point of access on how benefit-sharing obligations will be operationalised and enforced. This is neither excessive nor unreasonable. It is fundamental to trust in the system.” Convergence Nepal, speaking for Southeast Asia, warns against weakening the link between access and benefit-sharing. Nepal, speaking for WHO’s South East Asia region, stressed “the importance of ensuring that the PABS system preserves the intrinsic linkage between access and benefit-sharing. “Approaches that risk weakening this relationship or introducing fragmentation from the outset would not provide a sustainable or equitable foundation for the system we are mandated to establish,” Nepal cautioned, apparently also in reference to the “hybrid” option. Meanwhile, another diverse group represented by the Dominican Republic, but including Australia, the Bahamas, Barbados, Malaysia, Mexico, Norway and Singapore, offered to be a bridge to find “convergence” for a “sufficiently clear, credible and operationally effective” PABS system. Meanwhile, the EU also expressed regret at the failure to reach agreement, expressing its full commitment to “finalise and agree on a PABS system that will make a real difference and truly change things on the ground”. The European Union regrets that IGWG was unable to reach agreement on PABS. ‘Disservice to humanity’ The next IGWG will be from 6 to 17 July, and the new aim is for a PABS annex to be ready for next year’s World Health Assembly. Closing Friday evening’s session WHO Director General Dr Tedros Adhanom Ghebreyesus acknowledged that the talks have been “a roller coaster”. “Real progress was made on the PABS annex, but important differences remain. Please stay engaged. We need everyone. My one piece of advice is this: please approach the outstanding issues with a sense of urgency, because the next pandemic is a matter of when, not if,” said Tedros. Echoing this warning, Helen Clark and Ellen Johnson Sirleaf, co-chairs of The Independent Panel for Pandemic Preparedness and Response, said that “a lack of action to prevent and prepare for the next pandemic threat is a disservice to humanity”. They called on governments to do more on pandemic prevention, preparedness, and response (PPPR): “All countries must be able to detect and rapidly report outbreaks which may pose an international threat.” However, they also acknowledged that many low- and middle-income countries are impacted by high debt levels, and a sharp decline in development assistance. “Leaders have an opportunity to demonstrate their commitment to protect humanity at the upcoming UN High-Level Meeting on PPPR in New York in September. “There, they must make progress to fill enduring gaps in PPPR including on co-ordination, financing, equity, and accountability. They should also make it clear that the PABS Annex must be finalised to enable the WHO Pandemic Agreement to proceed.” Methane Emissions From Fossil Fuels Near Record Highs 04/05/2026 Stefan Anderson An infrared camera reveals escaped methane emissions from oil rig. Methane leaks from oil and gas make a major contribution to global warming. Methane emissions from fossil fuels stayed near record highs in 2025, with no sign of decline despite proven, low-cost ways to reduce them, the International Energy Agency (IEA) said on Monday. “Methane emissions from the energy sector plateaued near record highs,” the IEA found in its annual Global Methane Tracker. “There is still no sign that methane emissions from fossil fuel operations are falling, despite well-known and proven mitigation pathways.” The findings land halfway towards the 2030 deadline for cutting global methane emissions by 30%, a target that 159 countries and the European Union (EU) set under the Global Methane Pledge. A UN assessment released at COP30 found nations were on course to deliver less than a third of that. Methane is responsible for nearly 30% of the rise in global average temperatures since the Industrial Revolution. With an atmospheric lifespan of around 12 years, against centuries for carbon dioxide, cutting it is one of the fastest available levers on near-term warming, often described as the climate “hand brake”. More than half of global oil and gas output is now covered by company pledges to near-zero methane emissions, up from less than 20% in 2021. But the report found a “large implementation gap” between commitments and outcomes. “Countries and companies have raised their ambitions on methane, moving the issue higher up the policy agenda,” said Tim Gould, the IEA’s chief energy economist, who presented the findings at a high-level event in Paris convened by France’s G7 presidency. “However, setting reduction targets is only a first step, and it is important to ensure they are backed up by policies, implementation plans and real actions.” Fossil fuel production drives methane Oil, gas and coal production reached record levels in 2025, the IEA found. While the report found the global average upstream methane intensity of oil and gas production has fallen by around 10% since 2019, the IEA estimates total methane emissions from fossil fuel activities remain at 124 million tonnes a year, equivalent to the annual emissions of around three billion cars. Methane is the main component of natural gas and is emitted across the fossil fuel supply chain: vented from equipment by design, flared incompletely, leaked from valves, pipelines and storage tanks, or released from coal mine ventilation shafts, inextricably tying methane emissions levels to oil, gas and coal production. Oil is its largest source, releasing the equivalent of around two-thirds of the EU’s annual gas imports. Coal follows closely, then natural gas, the report found. A further 20 million tonnes comes from the incomplete burning of wood, charcoal and other traditional fuels in developing economies, principally used for cooking. Around 70% of methane emissions from fossil fuel operations could be cut using existing technology, the IEA said, with more than 35 million tonnes avoidable at no net cost as the price of gas offsets the investment needed to capture it. “This is not only a climate issue,” Gould said. “There are also major energy security benefits that can come from tackling methane and flaring, especially at a time when the world is urgently looking for additional supply amid the current crisis.” European Union energy chief Dan Jorgensen, speaking at the G7, added that capturing the gas being lost would significantly ease pressure on global markets. “We could have three times more gas on the market if we eliminated this waste,” Jorgensen said. “This shows that methane abatement and energy security are not competing priorities.” “Methane is the single fastest lever we have to limit near-term warming. We can no longer wait to pull this lever.” Pledges expand, emissions don’t The push for methane action accelerated at COP26 in Glasgow in 2021, where the United States, the EU and more than 100 other countries launched the Global Methane Pledge. The pact now covers 159 countries and nearly three-quarters of global oil and gas production. Five years on, COP26 president Alok Sharma, who guided the methane pledge across the line, said action is not living up to the scale required to abate the climate crisis. “Things are looking much bleaker than they were,” Sharma told a high-level meeting at IEA headquarters on Friday. “We breached 1.5°C last year and the year before, temporarily, and frankly, the prognosis is not good.” With no decline in fossil fuel emissions globally in 2025, atmospheric methane concentrations continued to rise. The IEA estimates that more than 85 million tonnes of fossil-fuel methane in 2025 came from the 10 biggest emitters: China, US, Russia, Iran, Turkmenistan, India, Venezuela, Indonesia, Kazakhstan and Iraq. Together, they account for around 70% of global fossil fuel methane emissions. The methane intensity of oil and gas production, or emissions per unit of energy delivered, varies widely, with the best performers scoring more than 100 times better than the worst, according to IEA data. Norway has the lowest upstream intensity in the world, the IEA found, achieved through a national ban on non-emergency flaring and a tax on venting and flaring introduced in 2015. Producers in the Middle East, including Saudi Arabia and the United Arab Emirates, also perform relatively well, according to the report. Turkmenistan and Venezuela have by far the highest intensities, the result of ageing Soviet-era and decrepit state-run infrastructure operating with little regulatory oversight. Independent analysis from the Stop Methane Project at UCLA found Turkmenistan dominated the list of the 25 worst-emitting facilities globally in 2025, emitting a “mind-boggling” amount of methane experts say could be easily contained. If every country matched Norway’s methane emissions intensity, global oil and gas methane emissions would fall by more than 90%, the IEA found. “Action on methane is not a fight of any single actor and nobody can win it alone,” French environment minister Monique Barbut said at the Paris event. “We must be clear: the energy sector offers today the fastest and often the most cost-effective reductions.” COP presidents press for action The IEA report was previewed at a high-level event at the agency’s Paris headquarters last week, where the COP31 presidency, made up of Turkey and Australia, set out priorities for the November summit in Antalya. Laurent Fabius, the former French prime minister who shepherded the Paris Agreement at COP21, said methane should be a central focus in Turkey, where the UN Environment Programme is expected to release its annual Eye on Methane report. Last year’s edition, launched at COP30 in Belém, found current national commitments would cut global methane emissions by just 8% below 2020 levels by 2030, under a quarter of the pledge target. “Methane is the faster way of trying to diminish global warming,” Fabius said. “Progress has been made. Pledges do exist, efficient techniques too, but we know that it is not enough. Methane should be one of the stars of COP31.” Sharma also pressed the point on finance, which he said was still falling far short of what was needed. Global clean energy investment reached a record €2.3 trillion last year, but a third of what was needed by 2030. Only 10% had gone to hard-to-abate sectors, and more than 80% to East Asia, Europe and the United States. Excluding China, developing countries representing 30 to 35% of global emissions were not getting the finance they need, he said. “We’re still nowhere near the scale that we should be … If you want to transition away from fossil fuels, you need to provide the finance for people to do that,” Sharma said. “We need to make sure there’s grant support to help developing nations look at their regulatory regimes.” “There will be some people who will say, and they’ve said it in the past, that the COPs are not the place this nitty gritty discussion on finance. That’s wrong. That is totally wrong,” Sharma said. “It is absolutely the place where we ought to be having discussion about these details on finance.” Simon Stiell, the UN Climate Change Executive Secretary, framed the energy crisis triggered by the war in the Middle East as an argument for accelerating the transition itself, which would in turn cut methane at source by reducing demand for the fossil fuels that produce it. “Those who’ve fought to keep the world hooked on fossil fuels are inadvertently supercharging the global renewables boom,” Stiell said. “This latest fossil fuel cost crisis has made the economic logic of renewables impossible to ignore.” “Renewables offer safer, cheaper, cleaner energy that can’t be held captive by narrow shipping straits, or global conflicts,” Stiell said, adding that “slashing methane” should be one of the most urgent priorities of COP31 for its potential to deliver “fast climate benefits while saving money.” Clean cooking and the bioenergy gap Around 18 million tonnes of methane emissions in 2025 came from the roughly 2 billion people worldwide who cook on open fires or simple stoves burning wood, charcoal and agricultural residues, with serious consequences for human health and the environment. Nearly half of them live in sub-Saharan Africa, where four in five households have no access to clean cooking technology, according to data released at the IMF Spring Meetings. The smoke produced exposes mostly women and children to particulate matter and carbon monoxide, driving severe respiratory and cardiovascular disease. Cooking with solid fuels is linked to 815,000 premature deaths a year globally, and household air pollution from these fuels remains one of the leading environmental health risks worldwide. “Expanding access to clean cooking solutions, including liquefied petroleum gas, electricity, improved biomass stoves and clean biofuels, offers further scope to cut methane emissions while delivering substantial health, gender and economic benefits in communities most affected by traditional biomass use,” the report said. Clean cooking is one of the COP31 presidency’s stated priorities, alongside electrification, zero waste and finance, representatives of the presidency from Turkey and Australia said. “Electrification, clean cooking, zero waste and finance, these are things that we can all gather around,” said Australia’s ambassador Stephen Jones, deputising for the country’s COP31 negotiations president. Jones said the climate transition and the response to the energy crisis were the same fight. “The clean energy solution is the solution to the energy crisis that we are now engaged in,” he said. “Paris is working. But we have to work faster and put more effort in.” Image Credits: Clean Air Task Force , IEA, IEA . Big Tobacco is No Longer Selling Cigarettes – It Is Engineering Addiction 04/05/2026 Hans Henri P. Kluge The tobacco industry is using sophisticated marketing aimed at young people. Europe needs a more precise focus to address the tobacco industry’s “engineered architecture of addiction”, featuring flavoured tobacco and nicotine products with ever more sleek designs. As an early champion of global tobacco legislation, the region can reposition itself to lead again – including through updated European Union directives on tobacco product regulation, advertising and taxation. Twenty-one years ago, the WHO Framework Convention on Tobacco Control (FCTC), the world’s first global health treaty and one of the EU’s earliest major public-health commitments, entered into force. It has helped to drive a reduction in tobacco use, with over 120 million fewer people using tobacco worldwide and best-practice protections expanded to more than six billion people. As a new WHO/ Europe report, published last year to mark the treaty’s 20th anniversary, shows, its core principles remain relevant – perhaps even more so today, as new products and tobacco industry tactics disrupt public health progress in unprecedented ways. Tobacco remains one of the world’s most lethal health hazards, killing more than seven million people globally each year, including an estimated 1.6 million non-smokers who are exposed to second-hand smoke. The WHO’s European Region, with 53 member states, has the dubious distinction of being the world’s leader in tobacco use, as well as the global leader in growing e-cigarette use among youth. Tobacco use trends (2000-2030) The scale is stark: in 2024 alone, 173 million adults and four million adolescents aged 13-15 were tobacco users, alongside 31.4 million adults and 4.2 million adolescents using e-cigarettes. What is increasingly evident today is that the danger is no longer confined to tobacco itself. It has shifted toward the engineered architecture of addiction – products designed to attract new consumers, sustain dependence and undermine public health. Flavours, filters, and sleek designs for Gen Z and younger The tobacco industry is much more than harvesting, curing, or rolling leaves. It now has sophisticated products and advertising machinery built to capture attention, personalise user experience, stay one step ahead of regulation and hook consumers long before they ever touch a cigarette. The tobacco and nicotine industry now markets an expanding universe of products – from heated tobacco and e-cigarettes to “aromatic nose inhalers” and nicotine pouches. Most of these products contain nicotine in different forms and concentrations, flavours and all of them exploit desire, reward pathways and the psychological hooks of habit and dependence. If, in the last century, cigarettes were marketed by images of rugged masculinity and reassuring doctors, today’s new generation of tobacco and nicotine products is packaged in joyful, playful social media posts attuned to millennials, Gen Z and younger audiences. There is bright packaging, unboxing videos, or lifestyle clips that blur the line between advertising and entertainment. Many play along, click, like and share. New products are being designed to attract children and young adolescents, mimicking candies and toys. The strategy remains the same: to make nicotine and tobacco products look modern, harmless, and desirable. Much of this content is not presented as advertising at all. The addictive architecture of social media does the heavy lifting. Influencers trusted by millions of young followers may feature these products under the guise of authentic personal recommendations, while in reality contributing to the industry’s transnational marketing reach. Viral ads multiplied by trust is a very powerful combination that does much harm in the wrong hands. This concerns me personally. As a father of two daughters, I can see how important social media is for them. It gives the feeling of emotional connection, belonging, and significance. And this is true for me as well – I can feel social media influencing my worldview and my work at WHO/ Europe every day. Full implementation of Framework Convention on Tobacco Control One of the most striking findings in the WHO/ Europe report is that the most powerful tobacco-control measures are already known and proven to work, but their adoption and proper implementation at country-level is lacking. Since 2019, rates of adolescent e-cigarette use have increased in 22 of 25 EU countries reviewed, and in all of them, girls report higher use than boys. Tobacco use among women in the EU remains high and sharply contrasts with the global downward trend. This is in line with the findings of the European Commission’s latest evaluation of the EU tobacco control framework, which highlights the rapid rise of novel tobacco and nicotine products — especially among young people — as a key and growing challenge. All of this points to one conclusion: full implementation of the WHO FCTC is overdue. The EU’s existing directives – the Tobacco Products Directive, the Tobacco Advertising Directive, and the Tobacco Taxation Directive – must be updated and strengthened to deliver on the treaty’s commitments . Today’s major problems include uneven implementation, regulatory loopholes, and slow adaptation to new products and new realities of digital marketing –all influenced by the tobacco industry. A strong political commitment is necessary to overcome these challenges and change the trajectory of nicotine and tobacco use. Europe can lead once again By accelerating implementation, closing regulatory loopholes, modernizing legislative frameworks to address digital marketing, and applying effective price and tax measures, the EU can set a powerful global example and advance the vision of a Tobacco-Free Generation by 2040, an ambition set out in Europe’s Beating Cancer Plan, and later re-iterated in the EU Safe Hearts Plan. Twenty years on, the FCTC continues to provide a strong foundation, but today’s market realities call for its full implementation that is complemented by forward-looking measures. As an early architect and champion of the FCTC, the EU is uniquely positioned to lead once again – and this leadership will be most effective if exercised without delay, ensuring that policy not only keeps pace with, but anticipates, emerging products and industry tactics. Hans Henri Kluge is the regional director of the WHO/European Region. Image Credits: Filter, WHO, WHO. Landmark EU Vote Demands ‘Only Yes Means Yes’ Rape Law, Targeting Gaps in Survivor Care 01/05/2026 Felix Sassmannshausen Legislators Joanna Scheuring-Wielgus and Evin Incir present the parliament’s demand for a rape law based on an ‘only yes means yes’ principle. STRASBOURG – Amid a global backlash against sexual and reproductive rights, the European Parliament has taken a decisive stand by voting for a unified, human rights-based standard for sexual offences. This Europe-wide legislative push aims to overhaul the fragmented national laws that currently leave many survivors without access to justice or essential health support. The resolution formally urges the European Commission to draft binding laws that recognise rape is fundamentally defined by a lack of consent. This represents a stark departure from outdated national models that require victims to physically fight back or explicitly say no. Swedish lawmaker Evin Incir addresses the European Parliament. “It is both morally and legally unacceptable that women are not protected by ‘only yes means yes’ legislation across the EU,” leading lawmaker Evin Incir from the centre-left social democrats (S&D) declared following the plenary vote on Tuesday. Just hours earlier, the European Parliament had adopted a landmark report with 447 votes in favour, 160 votes against, and 43 abstentions, demanding a unified standard for sexual offences. The push for reform is driven by a societal reckoning, spurred by cases that have sparked international outrage, such as that of Gisèle Pelicot in France. During a high-profile 2024 trial, the public learned that Pelicot’s husband had covertly drugged and raped her over a decade, also inviting dozens of men to rape her while she was unconscious. Human rights baseline: only yes means yes Comparison between outdated force-based legal requirements and the Parliament’s proposed standard of affirmative, voluntary consent. At the core of the European debate is the push for an ‘only yes means yes’ principle to ensure that any sexual act without freely given consent is legally classified as a crime. While a clear verbal “yes” is the most direct method, legal experts emphasise that consent can be expressed in any voluntary and unambiguous way, meaning affirmative gestures or reciprocal actions, depending on the specific context of the relationship. Establishing legislation focused on the lack of consent is widely viewed as the necessary next step to implement the Istanbul Convention. Opened for signature in 2011 and ratified or acceded to by 39 parties, Article 36 of this comprehensive international treaty explicitly requires member states to criminalise all non-consensual sexual acts, setting a clear human rights baseline. A unified legal definition is essential for health policy, as it directly impacts how survivors access emergency contraception, trauma counselling, and forensic medical care. Recognising the health sector’s critical role in this recovery process, the WHO Regional Office for Europe provides health system baseline assessments to help stakeholders monitor member states’ compliance with the Istanbul Convention. The latest comprehensive EU gender-based violence survey reveals that a staggering 30.7% of women across the bloc have experienced physical or sexual violence, which aligns with global data. Crucially, 8.4% of women report being raped while under coercion or being unable to refuse, nearly double the 4.8% who experienced overt physical force. Despite this high prevalence, systemic barriers continue to suppress official reporting and hinder access to post-rape care. Only 13.9% of victims ever contact the police, frequently citing embarrassment, fear of retaliation, or a belief that law enforcement cannot help them as their primary reasons for silence. Acknowledging trauma and fear responses Neurobiological evidence from the Karolinska Institute shows 70% of survivors experience paralysis, supporting calls for an ‘only yes means yes’ approach. A critical aspect of focusing on the lack of consent involves officially recognising the physiological realities of trauma. Medical experts and victim advocates continuously stress that a lack of physical resistance does not equate to a voluntary agreement. Co-rapporteur Joanna Scheuring-Wielgus during the plenary debate. Legislators underscored the neurobiological “freeze” response, where a victim perceives overwhelming danger, and the body is rendered completely paralysed. “It’s important to understand that a victim may not always have the strength to fight, to say no,” Polish co-rapporteur Joanna Scheuring-Wielgus explained at the press conference. While some victims might actively fight back, others can also freeze or faint. A 2017 Swedish study from the Karolinska Institute found that 70% of sexual assault survivors experience significant “tonic immobility,” an involuntary, temporary state of motor inhibition triggered by intense fear. Current legal systems in several member states routinely dismiss cases where victims experienced this involuntary physiological paralysis, which the European Parliament notes causes severe secondary victimisation. Furthermore, victim support networks like Women Against Violence in Europe (WAVE) warn that failing to provide trauma-informed, gender-specific responses deters survivors from seeking essential medical and psychological support. Implementing laws based on an ‘only yes means yes’ principle would mandate that judges and law enforcement officials understand these complex trauma responses. Policy analysts argue this shift is vital for building trust in public institutions and ensuring that victims feel safe enough to access specialised healthcare services. Fractured legal landscape leaves survivors vulnerable German legal barriers create a stark gap between rising rape reports and actual criminal convictions. The contrast between different national models highlights why European lawmakers are demanding unified rules. In Germany, the current framework dictates that a victim must signal refusal, meaning perpetrators often escape conviction if the victim remains passive due to fear. According to recently published data from the Federal Criminal Police, 14,454 rapes were reported in Germany in 2025, an 8.5% increase that officials attribute primarily to a growing willingness among victims to come forward. However, the consequences of the current legal framework are still reflected in extremely low conviction rates, with the women’s rights organisation Terre des Femmes estimating that only one in one hundred rapes ultimately results in a conviction. Legal practitioners, including the German Women Lawyers Association, argue that this standard protects perpetrators rather than victims by shifting the responsibility of communication onto the assaulted person. They maintain that establishing the lack of consent as the legal threshold is the necessary next step to enable more victims to seek justice. Conversely, countries such as Sweden and Spain have recently reformed their penal codes to ensure that sexual relations must be affirmatively agreed upon. While Sweden has already recorded a subsequent rise in convictions due to broadened evidence admissibility, monitors note that Spain’s groundbreaking 2022 law has yet to translate into similar statistical increases. Political tide is changing in Europe After tough negotiations, the European Parliament voted for a unified legal standard based on an ‘only yes means yes’ principle on Tuesday. The road to a unified standard has been fraught with conflict. During the 2024 negotiations for the EU’s first Directive on violence against women, a blocking minority led by France, Germany, and Hungary successfully stripped rape from the final text. Rapporteur Evin Incir reminded the public of the “unholy alliance” of leaders – including Viktor Orbán and Emmanuel Macron – who formed this blocking minority. These national leaders had argued that the European Union lacked the legal competence to harmonise criminal laws on sexual violence. Only US Votes Against Women’s Rights Document at UN Commission However, the political winds are shifting. Mounting public pressure has forced national governments to reconsider, with countries like France now actively revising their own criminal codes to align with an ‘only yes means yes’-based model. Despite the momentum, the proposal faces fierce opposition from far-right factions who frame the initiative as an ideological overreach. During the Strasbourg debate, an MEP from the Patriots for Europe group argued that “human relationships do not unfold through formalized steps or legal checklists,” claiming the law would amount to morally policing intimate desire. Other right-wing voices attempted to pivot the debate toward anti-immigrant narratives, suggesting lawmakers should “protect the streets, not the bedrooms”. Progressive lawmakers swiftly rejected this framing, citing data that proves the vast majority of sexual assaults are committed by perpetrators known to the victim, underscoring the systemic, domestic nature of the crisis. More than judicial reform needed The proposed European standard combines legal reform with mandatory education and trauma-informed training for law enforcement. Establishing the ‘only yes means yes’ principle as the legal threshold for rape demands a fundamental re-evaluation of how European societies view sexual availability and interpersonal power dynamics. The core premise is that sexual partners must actively communicate their desires and mutually negotiate the boundaries of their intimacy. However, reforming the penal code to reflect the lack of consent is only one part of the broader societal transformation envisioned by the European Parliament. Lawmakers are heavily emphasising the need for mandatory, comprehensive sexuality and relationship education across all member states. To ensure these legal reforms are effectively applied, parliamentarians are also demanding mandatory, trauma-sensitive education for law enforcement officers to prevent secondary victimisation during police investigations. “Why in 2026 should it be controversial that we demand that it should be mandatory for those who are working to support these women and girls who are victims?” rapporteur Incir asked, pointing to the tough negotiations with conservative co-legislators. The European Commission has signalled its readiness to support this cultural shift by mapping the current legal landscape across the Union to identify further legislative action. However, it could take years before an EU-wide law takes effect: after the Commission proposes a legal framework, the parliament and EU member states have to negotiate their positions and find a compromise. Image Credits: Felix Sassmannshausen/HPW. Energy Transition ‘Past Point of No Return,’ 57 Nations Declare at First Fossil Fuel Phase-Out Summit 01/05/2026 Stefan Anderson Coalition launches first sustained diplomatic push to phase out oil, gas and coal as war in the Middle East exposes the costs of fossil fuel dependence. The first international conference on phasing out the oil, gas and coal igniting the climate crisis ended with 57 governments representing every continent and a third of the global economy declaring the transition away from fossil fuels is now irreversible. “Actions taken to date prove that the energy transition is past its point of no return,” the coalition declared in its closing document, affirming all members were “ready to advance their transition away from fossil fuels.” The momentum is partly driven by concern for the planet, but also by a strategic desire for the energy independence that renewables could provide in an era of geopolitical instability – a case sharpened by the havoc the war in the Middle East was wreaking on the global economy as delegates gathered on Colombia’s Caribbean coast. “In a time that has been marked by fragmentation, that has been affected by war, by mistrust and the climate crisis, to sit here together and talk about the challenges, talk about the taboos, it’s a deep transformation of policy,” Irene Vélez Torres, Colombia’s environment minister and conference co-chair, said in her closing remarks in Santa Marta. Conference co-chairs Irene Vélez Torres, Colombia’s environment minister, and Stientje van Veldhoven, the Dutch climate minister, celebrate at the closing plenary. “When they look back at us from the future, they will remember that we were there, working on the challenges of our time,” Vélez Torres added. “That we decided not to focus on an economy built on war and destruction — we decided instead that it was necessary to prioritise life, security, certainty, sovereignty and solidarity.” The conference produced no binding commitments, no finance pledges, no promises of emissions cuts — that wasn’t the point. Instead, organisers pitched the summit as a “safe space” for countries already committed to phasing out fossil fuels to speak frankly. No negotiations, no consensus text to be watered down, no red lines passed down from governments to throw a wrench into discussions. A space free of the fossil fuel lobbyists who fill the corridors of UN climate summits by the thousands, both openly and embedded in petrostate delegations, often outnumbering full national delegation teams. “The fact we didn’t have negotiations here makes for such a different dynamic,” said Stientje van Veldhoven, the Dutch climate minister and co-chair alongside Vélez Torres. “The psychology of the Santa Marta process is something that we will definitely make sure to carry forward.” A coalition born of frustration Two weeks of negotiations in Belém, Brazil, failed to address a phase-out plan for coal, oil and gas as more than 100 nations blocked language on the fossil fuels at the root of the climate crisis. Three years on from the COP28 breakthrough in Dubai, where nearly 200 countries agreed to “transition away from fossil fuels,” efforts to translate the pledge into concrete action have hit a wall. Negotiations to agree a phase-out roadmap at COP30 in Brazil last November were torpedoed by a coalition of petrostates led by Saudi Arabia, which drew over half of the nations in attendance to its side in opposing the plan. The final text in Belém contained no reference to “fossil fuels” at all, a marked step backwards for the UN climate process. Without that failure, the Santa Marta conference would not exist. Conceived in the hours after COP30 collapsed, the new process was born of frustration with the gridlock of consensus-based UN climate diplomacy. But its architects stressed that it is meant to be complementary to mainstream COPs, not to replace them. “It’s very important that we agree on the fact that we want this conference, this process, to be like an accelerator for what we want to do in the context of UNFCCC,” van Veldhoven said, adding that the chairs have already been in touch with the COP31 presidency. Alongside government ministers, the conference included nearly 3,000 representatives of subnational governments, trade unions, scientists, civil society groups, Indigenous Peoples, women’s organisations and youth representatives, all named in the closing document as equal participants rather than observers, the title they hold in UN negotiations. “A new reality is taking shape: this is no longer a one-off moment, but the foundation of an ongoing international process dedicated to phasing out fossil fuels,” said Kumi Naidoo, president of the Fossil Fuel Treaty Initiative. “What is emerging is a process that can finally match climate diplomacy to the scale of the crisis.” Countries will attempt to carry the momentum forward at the next phase-out conference, confirmed in the closing hours to be held in 2027 on the Pacific island of Tuvalu and co-hosted by Ireland, pairing a wealthy European island with one across the globe at risk of disappearing under sea-level rise. “We are making history. We have proven, in the words of our youth, that another way is possible,” Tuvalu’s representative said. “The world is in a fossil fuel crisis, of climate breakdown, of conflict, of instability. But here in Santa Marta, we have planted a seed of solutions.” The tailwind from Hormuz Roughly a fifth of the world’s oil passes through the Strait of Hormuz, where wartime disruptions have driven prices to their highest level in years and exposed how much the global economy still depends on fossil fuels. Running through the conference was the war between Israel, the United States and Iran, which has disrupted shipping through the Strait of Hormuz, tightening gas supplies across Europe and Asia and skyrocketing oil prices to their highest level in years. On the same day delegates closed proceedings, US President Donald Trump told reporters Iran would have to “cry uncle” before he lifted what he called his “genius” blockade. Brent crude hit $126 a barrel hours later, approaching the spike that followed Russia’s invasion of Ukraine in 2022. For the three-quarters of the world that depends on fossil fuel imports, the message of the past five days was hard to miss: their energy costs, inflation rates, fiscal stability and the prices their citizens pay for food and fuel are tied to decisions made by a handful of leaders in Washington, Moscow and Riyadh – none of whom were in Santa Marta. The coalition’s closing document named the Hormuz crisis directly, calling the disruptions a demonstration “that reducing fossil fuel dependencies is critical” to “keep our planet livable, to safeguard energy security, and to build economic resilience to volatile fossil fuel markets.” “Destructive oil wars, widening fuel and food shocks, and a mounting climate crisis only bolster the conviction that breaking free from the fossil fuel system is not a matter of magical realism but of radical realism, in line with science and the law,” said Nikki Reisch, director of climate and energy at the Centre for International Environmental Law. Van Veldhoven framed the crisis as part of the case for moving faster. “If these countries significantly reduce their dependency on fossil fuels, it means they’ll be investing in their own economy instead of importing fossil fuels from abroad,” she told Bloomberg. “It means they’ll be investing in clean technologies, but it also means they’ll be shielding their economies against the kind of price shocks we’re seeing currently.” Santa Marta: Key outcomes from first summit on ‘transitioning away’ from fossil fuels | @daisydunnesci Read here: https://t.co/YGUgQR5BTg pic.twitter.com/1nZuILSPO7 — Carbon Brief (@CarbonBrief) May 1, 2026 France became the first major economy to act on that argument at scale during the conference, releasing a national roadmap to eliminate fossil fuels from its energy mix by 2050. The plan does not introduce new pledges but consolidates existing French climate and energy targets under a single explicit goal: ending the use of oil, gas and coal for energy purposes by 2050. Globally, the picture is mixed. Fossil fuels remain responsible for more than 75% of greenhouse gas emissions, but new renewable capacity in 2025 is nearly 50% higher than in 2023, and renewables are meeting nearly all new energy demand, according to the International Energy Agency. Investment in the energy transition reached a record $2.4 trillion in 2024, more than double 2019 levels, though it is concentrated in advanced economies and China, IRENA found. “This momentum is not yet enough to deliver the needed breakthrough,” said Bronwen Tucker, public finance lead at Oil Change International. “The richest polluting countries must take immediate action to accelerate their transitions at home and show up with meaningful international economic cooperation.” Coalition of the self-aware For all its ambition, the coalition openly admitted the limits of its own reach. The outcome document released in Santa Marta lays out in candid detail the shortcomings of the coalition in Colombia, and the distance all nations still have to go to achieve the transition away from fossil fuels. Chief among these admissions is the degree to which most nations in attendance continue to be dependent on oil, gas or coal for the public revenues that fund health, infrastructure and other government functions, and ensure energy security. Until governments find a way to replace that funding, walking away from fossil fuel production remains off the table. “The countries present in Santa Marta still have structural dependencies to overcome, including fiscal dependencies, debt constraints, the dependence of the financial architecture on fossil fuels,” the outcome paper states. “Transitioning away from fossil fuels is more than replacing one energy source with another … the transition itself is complex.” Many others simply do not have the financial headroom to invest in renewables due to looming debt payments and empty balance sheets. “We must confront economic dependence on fossil fuels that shape the realities we face,” Tuvalu’s delegate said. “Unsustainable debt, reliance on fossil fuel revenues, and a global financial system that was not built for us, and too often fails us.” The coalition also recognised the limits of its own power. While the alliance contains a meaningful contingent of major fossil fuel producers – Norway, Canada, Australia, the United Kingdom, Brazil, Mexico, Nigeria, Angola and Colombia itself – what it does not contain is a critical mass of global fossil fuel supply or demand. The 57 countries present make up about a fifth of global fossil fuel production, a third of oil and gas demand, and the same share of world economic output. The five biggest fossil fuel producers – the United States, China, Russia, India and Saudi Arabia – were all absent. Together, they control nearly half the world economy, and pump about 45% of the world’s oil, half its natural gas and three-quarters of its coal, far outstripping the heft of the Santa Marta coalition on all fronts. “We are here with an immense group, and yet it is still too small a group for what our ambition actually is,” van Veldhoven said. “Let’s make sure that we continue to drive this process as an open coalition. That means we have to ensure visibility of the outcomes and use that as an invitation to others to join us.” Rockstars to the rescue Attendees gather for the launch of the Science Panel for the Global Energy Transition (SPGET) in Santa Marta. A concrete outcome of the summit is the creation of a new scientific panel to advise nations on the practice and policy of the fossil fuel phase-out, an idea born in the halls of COP30, which Vélez Torres pitched as a sort of climate scientists’ Avengers team of “rock star academics”. “This panel not only repairs a historical debt of an organisation dedicated, finally and for the first time, to overcoming fossil fuels in the energy matrix,” she said, “it will also tell us about other types of challenges regarding the social and economic limitations of being able to carry out this transition as quickly as possible.” The Science Panel for the Global Energy Transition (SPGET) will unite over 100 scientists and academics to guide nations in policymaking and emissions pathway analysis with the goal of keeping the 1.5°C warming target enshrined in the Paris Agreement alive. The independent panel will focus on mapping policy options, green technologies and financial mechanisms that can be harnessed by countries to reduce emissions and fossil fuel dependence. Johan Rockström, director of the Potsdam Institute for Climate Impact Research and co-lead of SPGET, said it will operate as a “scientific service” to governments, helping them figure out the balance of energy supply and demand with a “scientifically aligned, just and orderly phase out of fossil fuels.” “[The panel] will also enable us to have feedback into the COP process so that we can keep the fossil fuel phase-out discussions in plenary at the COP meeting alive,” Rockström said. “Now is the moment to tip the scales, to not allow anymore that a few actors at the COP meetings always block the most important discussion of them all: the phase-out of coal, oil and gas.” The hard the work begins Delegates arrive for high-level ministerial sessions in Santa Marta, Colombia. The final agreement struck at Santa Marta establishes three “workstreams”: working groups of countries, experts and civil society that will meet between now and the next conference to develop policy options on the thorniest questions of the phase-out. The first will focus on national emissions roadmaps, taking specific aim at what Vélez Torres called the “punto ciego,” or blind spot, in the Paris Agreement: exported emissions. Under the Nationally Determined Contributions (NDCs) mandated in the Paris Accords, countries report emissions on a territorial basis, but not the emissions from fossil fuels they extract and sell to other countries. For major exporters, the effect on emissions calculations is enormous. Norway’s exported emissions from oil and gas are roughly ten times its territorial emissions. Saudi Arabia’s full emissions footprint rises to two and a half times its reported emissions, closing in on 5% of global CO2 on its own. “We are not making clear commitments about how we are going to control the emissions that are exported from producing countries,” said Vélez Torres, whose country, Colombia, sees its emissions more than double when its coal and oil exports are counted. “We want to be very clear, very honest about how to transition away from production as well.” Winding down production is one of the most complex questions in the phase-out debate. If demand falls first, producer countries face collapsing revenues and an economic crisis. If supply falls first, importers face energy shortages. A complementary workstream announced in Santa Marta, backed by the OECD, will look at how exporters and importers can coordinate their wind-downs so the two declines move in step, avoiding a scenario where one side pulls back faster than the other, leaving producers without buyers or importers without fuel before clean alternatives can fill the gap. Money traps, and future hopes Indigenous Peoples’ representatives played a central role in the Santa Marta phase-out talks. The final workstream, supported by the International Institute for Sustainable Development, takes on what the co-hosts called the three “traps” holding states back from moving faster on fossil fuel phase-outs: finance, debt and subsidies. It is, in many ways, the hardest of the three. Without alternative revenues lined up, governments cannot turn off the tap on production that pays their bills. The constraint tightens further as interest payments squeeze public budgets and credit ratings for developing nations render borrowing exceedingly expensive, leaving fossil fuel revenue indispensable and crowding out renewables investment. Then there are the subsidies. Governments worldwide handed roughly $1.3 trillion in direct support to fossil fuel producers and consumers in 2022 to keep pump and power prices low, according to the IMF, and as much as $7 trillion once the unpriced costs of pollution and climate damage are factored in. The direct figure alone is more than half the $2.4 trillion the world invested in the entire energy transition the same year, tilting the market against cheaper renewables as subsidies keep expensive fossil fuels price-competitive. In Ghana, the financial realities of fossil fuel dependence remain too steep to overcome, its delegate told the conference, despite the country supporting the phase-out goal. “In Ghana, fossil fuels remain deeply tied to government revenues that fund essential public services and to our broader energy systems,” he said. “We need a fossil fuel treaty that creates the necessary architecture for a just transition.” Ten-year-old Paula Pedro from Colombia speaks at the closing of the Santa Marta conference. That the coalition is willing to talk openly about the financial dependency at the heart of the phase-out is, for many participants, the most encouraging signal to come out of Santa Marta. Whether it can build bridges and expand its membership as the climate crisis accelerates is the question that will loom over COP31 in Antalya later this year, and in the run-up to Tuvalu in 2027. With the workstreams set and the next conference scheduled, it fell to a 10-year-old from Colombia to remind the room what the diplomacy was for. “Of the 12 million children we have in Colombia, eight out of ten of us are affected by fossil fuels and weather changes,” Paula Pedro, representing the Colombian children and youth coalition, told the assembly. “What we need, for the children, is that the people in this room do the math, but not only on paper, but accomplish change as a matter of fact.” “We’re not only the future,” Pedro said. “We are the present and beyond.” Image Credits: Colombian Environment Ministry, Colombian Environment Ministry, COP30, ColomColombian Environment Ministrybian Ministry o, Colombian Environment Ministry, Colombian Environment Ministry, Colombian Environment Ministry. Heartbroken Families Face Huge Structural Barriers When Trying to Prove Medical Negligence in India 01/05/2026 Arsalan Bukhari & Naila Tabassum Indian families face a huge struggle to get timely access to medical records of loved ones who have died in Indian health facilities, while the police can only lay a charge against a doctor if an independent medical expert first confirms negligence. NEW DELHI – India faces thousands of medical negligence cases every year, but structural problems make it extremely difficult for patients’ families to find out what has happened to their loved ones – let alone win compensation when treatment has been botched. “A shadow of death is looming over us,” Ashwini Bajaj, a Haryana-based businessman, told Health Policy Watch, recalling the treatment of his 24-year-old son, Deshbandhu, more than a year after his death. In December 2024, Deshbandhu, an MBA student at Punjab University and Bajaj’s only son, developed a fever that lasted more than two days. On 26 December, he visited a hospital near his university in Chandigarh, where he was prescribed medicines and given a series of tests, including a liver function test (LFT). By the time the results came out later that evening, Deshbandhu had returned to his parents’ home in Hisar, around 200 kilometres away. The next day, he went to a private hospital there, but his condition deteriorated rapidly. His oxygen saturation dropped to 65%, and doctors warned of acute liver failure. “We were told his condition was very critical and that the hospital did not have the resources to treat him,” Bajaj said. “We were asked to take him to a super-speciality hospital. It felt as if the ground beneath our feet had slipped away.” Deshbandhu was shifted to a major private hospital in Gurugram. “My son was there for over three weeks. His condition kept deteriorating. He went with jaundice, and he developed intestinal obstruction, kidney stress, and pneumonia,” Bajaj said. A few days after his 24th birthday, which was on 20 January 2025, Deshbandhu died. Bajaj says he has been unable to return to work. His case reflects broader systemic gaps in India’s healthcare system, where delays in critical care, weak referral systems, and limited transparency can have life-threatening consequences — and the lack of updated national data continues to hamper accountability. Transparency in treatment Deshbandhu Bajaj (24), a mountaineer and an MBA student who died in January 2025. His father, Ashwini Bajaj, alleges medical negligence. “Initially, I thought the doctors tried hard to save my child, but when I obtained all the medical reports, which took three to four months to obtain, I realised much time was lost before the actual treatment started,” Bajaj said. “When I made a day-by-day chart, I realised that, for at least four days, my son didn’t get the treatment he should have. “Every evening, I used to get payment requests promptly on my WhatsApp. If they could send payment requests, why can’t they share procedural updates the same way?” Rujhan Dhawan, a lawyer at the Punjab and Haryana High Court, told Health Policy Watch such opacity is a major barrier to accountability. “A patient, once admitted, is entirely dependent on the institution not only for treatment but also for truthful disclosure,” he said. “Critical information about procedures and complications is often not readily accessible to families.” Bajaj’s family spent over ₹30 lakh ($33,000) on treatment. He says he is not seeking compensation, but a legal framework that mandates transparency. Not an isolated case Deshbandhu’s case is not an isolated one. According to the 18th Annual MedLegal Review, 65,000 medical negligence cases were filed in India in 2025 alone. Radha Sharma (49), a resident of Rajasthan’s capital city Jaipur, died days after being given a TB drugs although she had been diagnosed with a liver-related illness. In Jaipar, around 270 kilometres from Gurugram, 55-year-old tax consultant Kishan Kumar Sharma is fighting a case linked to the death of his wife, Radha. On 3 March 2025, she developed mild jaundice and was admitted to a private hospital. A test suggested Budd-Chiari syndrome, a rare liver disorder. However, despite a negative tuberculosis test, Radha was prescribed the TB drug, Isoniazid, said Sharma. Isoniazid should not be prescribed to patients with liver disease who have bilirubin levels over 4 mg/dL, according to World Health Organization (WHO) guidelines. But Sharma says his wife’s liver disorder was overlooked. Radha’s condition deteriorated rapidly, and she died on 18 March. “I have a simple question,” Sharma said. “Why was my wife given Isoniazid? Was it part of any established protocol or something else?” The risks highlighted by such cases reflect a broader global problem. According to the WHO, an estimated 138 million patients are harmed every year due to unsafe medical care. Lack of dedicated investigative body Nishant Bharihoke, an advocate at the Delhi High Court who specialises in medical negligence cases, told Health Policy Watch the core issue lies in the absence of a dedicated independent investigative framework. “India does not have a dedicated body specifically tasked with investigating deaths or serious injuries caused by medical negligence,” he said. “When a patient dies, and the family suspects wrongdoing, there is no authority whose sole function is to find out what happened.” Complaints are typically routed through State Medical Councils, which may form inquiry committees. Their decisions can be appealed to the National Medical Commission, but Bharihoke argues that the system is structurally limited. “The National Medical Commission’s primary mandate is to regulate medical education. Its disciplinary board has no independent investigators and no power to enter hospitals and examine evidence,” he said. He also pointed to a legal loophole: since these proceedings are not strictly judicial, false statements made before such bodies do not result in perjury charges. For families like Bajaj’s and Sharma’s, he said, this gap deepens the sense of injustice. When cases turn criminal Simran Chhabra (21), a resident of Gurugram and MA student at Amity University, was suffering from a simple cough and cold. She died within minutes of being administered an intravenous injection. The family is fighting a medical negligence case in a Gurugram court. The gap becomes even wider when negligence overlaps with criminal allegations. One such case is the death of 21-year-old Simran Chhabra. On 21 January 2023, she visited a private hospital in Gurugram with symptoms of cough and cold. According to a prescription her brother, Sourabh Chhabra, shared with Health Policy Watch, she was administered an intravenous injection of Dynapar. This is usually used to treat pain and inflammation associated with arthritis or after surgery. “As soon as the injection was fully administered, Simran collapsed on the bed and froth began coming out of her mouth,” Sourabh said. “Everything happened within minutes. I had no time to understand what was going on.” She was referred to another hospital, where she was declared dead. According to Bharihoke, the family’s legal representative, the doctor later claimed that multiple emergency interventions were carried out, including five additional injections and cardiopulmonary resuscitation (CPR), using drugs typically administered in cases of severe allergic reactions. However, the post-mortem report reviewed by Health Policy Watch raises questions. It records only two puncture marks on her body, and there is no mention of a cannula (an intravenous tube) being used. If multiple injections were administered, the family asks why there is no corresponding physical evidence. In this case, they argue, the medical account and post-mortem findings do not align. “Forget conviction or arrest, even registering an FIR in such cases often requires court intervention,” Bharihoke said. A FIR is a First Information Report (FIR) in Indian medical negligence cases, a formal document prepared by police under Section 154 of the Criminal Procedure Code upon receiving information about alleged criminal negligence. Absence of a legal framework Several structural barriers insulate medical health practitioners against negligence cases, according to legal experts. “In India, police usually cannot even register a case against a doctor unless an independent medical expert first confirms negligence,” Bharihoke told Health Policy Watch. “In most cases, doctors are reluctant to give such opinions, especially against their peers.” The challenge is compounded by access to evidence. Hospitals retain control over key records, case files, prescriptions, nursing notes, and CCTV footage while families often receive only partial or delayed documentation. India also lacks a statutory system guaranteeing timely access to medical records for patients and their families. There is no clear legal mandate requiring investigators to immediately secure hospital evidence. Tanvi Dubey, a Supreme Court lawyer, told Health Policy Watch the legal framework itself raises the bar for accountability. “Criminal liability in medical negligence cases is limited to gross negligence, not simple errors of judgment,” Dubey said. “This significantly narrows the scope for prosecution.” Even initiating an investigation can be delayed: “Authorities are allowed to conduct preliminary inquiries before registering a case, which often means waiting for medical opinions and slows the process.” Dubey also pointed to the continued reliance on what is known in Indian law as the “Bolam principle,” where a doctor’s actions are judged against a body of medical opinion. “This makes expert testimony central. Unless a complainant can produce strong contrary evidence, it becomes very difficult to establish negligence,” she said. While multiple legal remedies exist, including consumer courts, civil litigation, and disciplinary proceedings, Dubey noted that each comes with limitations. “Criminal prosecution is rare, civil cases are slow and evidence-heavy, and disciplinary proceedings do not always ensure compensation or thorough fact-finding,” she said. Compared with Western peers, India faces two major policy gaps in patients’ treatment: the absence of a national electronic medical record (EMR) system, and the lack of a digital system connecting labs directly to the consulting doctor. Currently, India doesn’t have a mandatory EMR policy applicable to healthcare organisations. Even today, prescriptions, clinical notes, and drug administration records are still handwritten in the majority of hospitals and almost all smaller clinics. This makes them more vulnerable to tampering, loss and destruction. The absence of a nationwide electronic medical record system adds another layer of opacity. In many facilities, records remain handwritten and vulnerable to alteration; a gap Bharihoke alleges was evident in Simran’s case. Urgent reform is necessary India’s Minister of Health Jagat Prakash Nadda. Legal experts are calling on authorities to establish an independent statutory body to investigate medical negligence. Only families with the financial means and emotional capacity to pursue long legal battles are able to take up medical negligence cases. For many others, the burden becomes too heavy to carry. While the rules may appear neutral on paper, experts say their impact is deeply unequal. Legal and policy experts argue that the most urgent reform is structural, particularly the creation of an independent statutory body tasked solely with investigating patient safety incidents, particularly in cases involving death, permanent disability, or serious injury. Such a body should have the authority to enter hospital premises, access medical records, secure CCTV footage, and record statements. Its findings should be made public, while the evidence it collects remains protected from use in criminal or disciplinary proceedings. In England, the Health Services Safety Investigations Body (HSSIB), established in 2023, follows this approach by conducting independent investigations into patient safety incidents. Globally, different systems offer alternative approaches to accountability. In the United States, oversight is spread across multiple layers: state medical boards regulate conduct, a national database tracks malpractice records, hospitals report serious incidents, and patients can pursue civil litigation. China follows a three-tier system, allowing patients to first negotiate with hospitals, then seek mediation, and finally pursue civil lawsuits. In parts of Europe, including France and the Nordic countries, no-fault compensation systems allow patients to receive compensation without proving negligence, making the process more accessible and less adversarial. Aviation and rail safety investigations have long operated on similar principles, focusing on systemic failures rather than individual blame. For India, experts say the lesson is clear. Accountability frameworks do not have to rely solely on litigation. A system built on independent investigation, timely access to evidence, and patient-centric redress could help provide answers to families like the Bajajs and Sharmas. Image Credits: César Badilla Miranda/ Unsplash, Felix Sassmannshausen. No Pandemic Agreement Annex by World Health Assembly, Says Civil Society 30/04/2026 Kerry Cullinan (Left to right from top) Third World Network’s moderator and speakers Lauren Paremoer, KP Gopakumar and Tamara Prisenburg form AIDS Healthcare Foundation. The final missing piece of the Pandemic Agreement – a pathogen access and benefit-sharing (PABS) system – is unlikely to be agreed on by the World Health Assembly (WHA) later this month. This was the view of civil society observers of the talks taking place at the World Health Organisation (WHO) headquarters in Geneva, who briefed the media on Thursday. The sixth round of talks is scheduled to end late on Friday night (1 May). Earlier in the week, WHO Director General Dr Tedros Adhanom Ghebreyesus told a Geneva media briefing that “key differences remain on key issues”. “I still see a common will to reach consensus, which means I continue to believe there is a way to reach consensus,” Tedros added. Although the notion of a “hybrid” PABS system is being discussed informally, its proponent, the European Union (EU), has not presented any formal text, Third World Network’s (TWN) KM Gopakumar told the media briefing, which was hosted by TWN and the AIDS Healthcare Foundation. While Brazil and Botswana have apparently indicated that they might support a hybrid or “blended” compromise, the Africa Group is opposed to it, according to the civil society representatives. WHO member states are negotiating how to share both information about dangerous pathogens and some of the “benefits” that manufacturers may develop from that information – namely, vaccines, therapeutics and diagnostics (VTDs). The “hybrid” or “blended” proposal is a mix of mandatory and voluntary measures for sharing pathogen information and any benefits that flow from this information. It de-links information-sharing and benefit-sharing. Gopakumar said that, in terms of the blended agreements, countries that shared pathogens “will have the freedom to choose to attach certain conditions for sharing the data and the sample, including benefit sharing requirements” or share without any conditions. Kill the efficiency Shifting the choice to individual countries would undermine the efficiency of a single PABS system as users would need to negotiate with the individual countries instead of through a centralised system, he argued. “If you have a hybrid system, first of all, it kills the efficiency [of a single system], and second, it’s going to debase the access and benefit sharing norms set by the international instruments like the Convention on Biological Diversity and the Nagoya Protocol. Any attempt to dilute benefit-sharing obligations would be a “disaster” for equity, said AHF’s Tamara Prisenberg. Lauren Paremoer of the People’s Health Movement said that the blended model introduces “a two-track system for accessing pathogens” that violates access and benefit-sharing on an “equal footing” specified in Article 12 of the Pandemic Agreement. One track would allow anonymous users to access pathogen data without upfront commitments to benefit-sharing or legally binding contracts. The other was in line with Article 12, permitting access to pathogens through databases and laboratories that would require users to register and commit to specified benefit-sharing. Earlier in the day, the Intergovernmental Working Group (IGWG) briefed civil society on text-based negotiations, but very little of the text they shared had been “greened” to show agreement. EXCLUSIVE: WHO Opens Nominations for Next Director General; Germany May Advance Former Merkel Aide, Helge Braun 30/04/2026 Felix Sassmannshausen, Elaine Ruth Fletcher & Editorial team WHO DG Dr Tedros Adhanom Ghebreyesus issued a call for nominations for the DG elections. He recently travelled to Berlin, where he met with high-level politicians and the WHO’s Pandemic Intelligence team. As the World Health Organization (WHO) formally opens the nomination process for the next Director-General, Germany now appears likely to propose Helge Braun, Chief of Staff in former Chancellor Angela Merkel’s government, according to Berlin insiders. But after slashing its global health budget, sources question whether a German candidate can win wide support from other WHO member states. WHO Director-General Dr Tedros Adhanom Ghebreyesus has formally issued a call to WHO member states for nominations to the DG elections, scheduled for May 2027, in an invitation sent on 24 April to all WHO member states. WHO confirmed this in an email to Health Policy Watch. The invitations had been sent via private letters to countries’ Geneva missions. The period in which member states may nominate candidates will now run for six months, until 24 September. Contenders who have until now remained in the shadows are expected to begin coming forward publicly with their candidacies at the World Health Assembly in May. From the German perspective, Berlin wants its financial weight reflected in executive influence at the multilateral level as the largest global health donor following the US withdrawal from the WHO in January 2025. The withdrawal, combined with the US non-payment of dues owed, thrust WHO into a budget crisis, prompting layoffs of about 25% of the workforce in the past year. German Foreign Ministry neither confirms nor denies The German Foreign Ministry, formally responsible for the nomination, declined to confirm or comment on Braun’s potential candidacy when responding to a query by Health Policy Watch. Germany’s other potential candidates include the contested former Health Minister Karl Lauterbach and the lesser-known Paul Zubeil. In contrast, Braun’s dual profile as an accomplished politician, skilled financial manager, and trained physician and researcher who successfully built cross-party bridges offers a distinct advantage. But he is little known outside of Germany. Bridge-builder with executive and medical expertise Former Chair of the influential German Budget Committee, Helge Braun (right), and former French Chair of the Finance Committee, Claude Raynal (left), in the Bundestag. The current WHO leadership landscape demands a candidate capable of managing deep institutional fractures and uniting a divided global community. Despite him being largely unknown in the international community, Germany could be expected to emphasise Braun’s extensive fiscal and crisis management experience in any candidacy it mounts. As ‘Head of the Chancellery’, effectively Chief of Staff, in Angela Merkel’s last term as Chancellor, from 2018 to 2021, Braun operated at the nexus of scientific advice and political implementation during the COVID-19 pandemic, notably comparing the Chancellery to an intensive care unit where acute problems must be solved. Between 2021 and 2025, Braun then chaired the powerful Budget Committee of the German Bundestag (Parliament), overseeing the distribution and management of hundreds of billions of Euros with strict discipline This profound understanding of macroeconomic management, coupled with his pragmatic defence of Germany’s controversial debt ceiling alongside crisis-driven special funds, makes him an attractive prospect for donor nations currently demanding more financial accountability and restructuring at WHO in Geneva. Serving as a central mediator across government ministries, Braun built a reputation as a highly pragmatic problem solver whose past domestic political affiliations will not necessarily dictate his future approach to global health governance. This pragmatism complements his longstanding political advocacy for research into infectious diseases like Ebola and malaria. And unlike many career politicians, Braun’s foundational expertise lies in medicine, having worked for years as an intensive care physician and anaesthesiologist. He returned to these roots in April 2025 by assuming the presidency of the University of Lübeck, an institution renowned for its focus on life sciences and artificial intelligence. Why the candidacy might spark concerns WHO member states are currently negotiating a pathogen access and benefit-sharing (PABS) system in Geneva. While Braun championed early interventions and massive digitisation projects in his role as Merkel’s Head of the Chancellery during the COVID pandemic, severe bureaucratic delays hampered the rollout of vaccination campaigns and testing strategies. This tarnished his crisis management legacy just as he exited the federal government. His domestic political capital suffered further damage during the December 2021 Christian Democratic Union leadership election, where he lost heavily to conservative rival Friedrich Merz, now Chancellor. Party members largely rejected Braun as an establishment candidate, perceiving him as too closely aligned with the moderate legacy of former Chancellor Angela Merkel. Additionally, it is questionable whether Braun would wield the necessary diplomatic connections and familiarity with foreign health systems to be effective on Day One of a term as WHO head. The Director-General must immediately command trust and authority on the international stage, particularly when dealing with health ministries and stakeholders in the Global South. Most notably, the German government opposed the release of COVID-19 vaccine patents during his tenure, drawing sharp criticism from international health equity advocates. Defending this refusal in May 2021, Braun wrote in a guest article for the German newspaper Die Zeit that “patent protection as a driver of innovation is not the problem in this crisis, but an essential foundation for its solution.” In the Global South, this track record could thus reinforce the perception that Germany defends pharmaceutical interests over equitable technology transfer – especially in the face of current PABS Annex negotiations. Recent reports from Tagesspiegel Background indicating that the former minister was approached by Germany’s Association of Research-Based Pharmaceutical Companies to become their next president, when the post becomes vacant at the end of 2026, might further fuel these concerns. Finally, Germany has been cutting back its Official Development Assistance (ODA) in general, including contributions to the World Health Organization, where it has historically been the largest member state donor after the United States. On Wednesday, the Merz government announced its 2027 budget plans with further ODA cuts following last year’s drastic 17% reductions. The likelihood of Germany fulfilling its original 2024 financial pledge to WHO for the current biennium (2026-27) also remains in doubt. “They can put forward a candidate, but I don’t think it’s going to get a lot of traction from other member states,” said one informed WHO source. “At a time when Germany is reducing global health funding to member states, I don’t think they can go ahead and claim the top seat.” Step back and support allied candidates? Braun served as Head of Chancellery under then German Chancellor Angela Merkel, seen here with WHO Director General Dr Tedros in Berlin in 2021. Furthermore, domestic opinion remains highly divided on mounting a campaign amidst the geopolitical strains on Chancellor Friedrich Merz’s coalition and Tedros has reportedly urged Germany to back allied candidates instead. At the same time, the desire to seize more leadership in the UN system remains strong after Germany’s failed previous attempt to secure the top role at the UN High Commissioner for Refugees in 2025. Currently, Germany is also pushing for another attempt at a UN Security Council seat. Should Germany put forward a candidate, Foreign Minister Johann Wadephul, who will make the final decision, also faces a stark choice between Braun and the better-known Karl Lauterbach, as well as Paul Zubeil with his strong international health and technical background. Advancing a WHO outsider like Braun against established public health veterans is a highly calculated risk for Berlin, which must first convince other European countries to rally behind him. In case Berlin formally nominates Braun, the success of his candidacy will depend entirely on how effectively the government can reframe his perceived lack of field experience and global networks as delivery on fresh, badly needed fiscal expertise and perspectives. Grappling with WHO’s funding crisis As the race for the next Director-General opens for formal nominations, the names of over a dozen high-profile potential candidates are still circulating – from Indonesia to the United Kingdom. Want to Become the Next WHO Director-General? Get in Line And the list is still growing. Among the newer names being floated is that of Dr Hanan Mohamed al-Kuwari, who served as Qatar’s Minister of Public Health until November 2024 and chaired the 153rd Session of the WHO Executive Board. Before joining the Hamad Medical Corporation in 1996, where she ultimately rose to managing director, al-Kuwari worked for Reuters and as a freelance health reporter. Holding a PhD in healthcare management from Brunel University and bringing early career experience from the WHO, she represents a highly networked voice from the Arab world, celebrated for her crisis resilience and for shaping the WHO’s recent global work programme. Dr Maria Neira, former WHO Director of Climate, Environment and Health Another candidate who has been mentioned is Spain’s Dr Maria Neira, who recently retired from WHO as the director of Climate, Environment and Health. An iconic spokesperson for the climate, environment and health movement, Neira is known as a telegenic personality and adroit politically. As a young medical doctor, she worked in emergency relief in Latin America and Africa, and later served as Spain’s Vice Minister of Health and Consumer Affairs as well as President of the Spanish Food Safety and Nutrition Agency. However, Spain also recently decided to nominate a candidate to head the UN Food and Agriculture Organization (FAO), when Qu Dongyu’s second term as Director General ends in July 2027, leaving doubts about whether it would want to mount yet another campaign, in parallel. Continuing decline in ODA and global health aid Drastic ODA cuts and reduced global health funding leave vulnerable populations in precarious conditions worldwide. Whoever is elected will have to continue grappling with the continuing long-term declines in donor-driven ODA, and particularly global health aid – directly to countries and to WHO. While WHO 2026-2027 $4.2 billion base budget is now 85% financed, according to Tedros’ comments on Wednesday, declines in ODA continue to cast uncertainty on how the remaining $630 million gap will be filled. It’s unlikely that the $260.6 million in assessed US contributions still due for years 2024-2025, before the withdrawal became official in January, will ever be repaid, conceded WHO’s Tedros at a Geneva press briefing on Wednesday. “We’re hoping to get the money, but no signals yet,” Tedros told journalists, adding: “No signals means maybe we may not be able to get the money. The likelihood could be not getting the money.” “We’re looking at nontraditional donors. We’re looking at international financial institutions and other ways to mobilize that 15%,” Tedros said, in terms of filling that gap. “It’s not that we won’t go to the traditional donors, but I think we’re expanding that donor base.” This article has been edited to reflect additional information regarding Dr Hanan Mohamed al-Kuwari’s early career as a freelance journalist. Image Credits: X/Dr Tedros, Deutscher Bundestag/Leon Kügeler, European Commission. 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Methane Emissions From Fossil Fuels Near Record Highs 04/05/2026 Stefan Anderson An infrared camera reveals escaped methane emissions from oil rig. Methane leaks from oil and gas make a major contribution to global warming. Methane emissions from fossil fuels stayed near record highs in 2025, with no sign of decline despite proven, low-cost ways to reduce them, the International Energy Agency (IEA) said on Monday. “Methane emissions from the energy sector plateaued near record highs,” the IEA found in its annual Global Methane Tracker. “There is still no sign that methane emissions from fossil fuel operations are falling, despite well-known and proven mitigation pathways.” The findings land halfway towards the 2030 deadline for cutting global methane emissions by 30%, a target that 159 countries and the European Union (EU) set under the Global Methane Pledge. A UN assessment released at COP30 found nations were on course to deliver less than a third of that. Methane is responsible for nearly 30% of the rise in global average temperatures since the Industrial Revolution. With an atmospheric lifespan of around 12 years, against centuries for carbon dioxide, cutting it is one of the fastest available levers on near-term warming, often described as the climate “hand brake”. More than half of global oil and gas output is now covered by company pledges to near-zero methane emissions, up from less than 20% in 2021. But the report found a “large implementation gap” between commitments and outcomes. “Countries and companies have raised their ambitions on methane, moving the issue higher up the policy agenda,” said Tim Gould, the IEA’s chief energy economist, who presented the findings at a high-level event in Paris convened by France’s G7 presidency. “However, setting reduction targets is only a first step, and it is important to ensure they are backed up by policies, implementation plans and real actions.” Fossil fuel production drives methane Oil, gas and coal production reached record levels in 2025, the IEA found. While the report found the global average upstream methane intensity of oil and gas production has fallen by around 10% since 2019, the IEA estimates total methane emissions from fossil fuel activities remain at 124 million tonnes a year, equivalent to the annual emissions of around three billion cars. Methane is the main component of natural gas and is emitted across the fossil fuel supply chain: vented from equipment by design, flared incompletely, leaked from valves, pipelines and storage tanks, or released from coal mine ventilation shafts, inextricably tying methane emissions levels to oil, gas and coal production. Oil is its largest source, releasing the equivalent of around two-thirds of the EU’s annual gas imports. Coal follows closely, then natural gas, the report found. A further 20 million tonnes comes from the incomplete burning of wood, charcoal and other traditional fuels in developing economies, principally used for cooking. Around 70% of methane emissions from fossil fuel operations could be cut using existing technology, the IEA said, with more than 35 million tonnes avoidable at no net cost as the price of gas offsets the investment needed to capture it. “This is not only a climate issue,” Gould said. “There are also major energy security benefits that can come from tackling methane and flaring, especially at a time when the world is urgently looking for additional supply amid the current crisis.” European Union energy chief Dan Jorgensen, speaking at the G7, added that capturing the gas being lost would significantly ease pressure on global markets. “We could have three times more gas on the market if we eliminated this waste,” Jorgensen said. “This shows that methane abatement and energy security are not competing priorities.” “Methane is the single fastest lever we have to limit near-term warming. We can no longer wait to pull this lever.” Pledges expand, emissions don’t The push for methane action accelerated at COP26 in Glasgow in 2021, where the United States, the EU and more than 100 other countries launched the Global Methane Pledge. The pact now covers 159 countries and nearly three-quarters of global oil and gas production. Five years on, COP26 president Alok Sharma, who guided the methane pledge across the line, said action is not living up to the scale required to abate the climate crisis. “Things are looking much bleaker than they were,” Sharma told a high-level meeting at IEA headquarters on Friday. “We breached 1.5°C last year and the year before, temporarily, and frankly, the prognosis is not good.” With no decline in fossil fuel emissions globally in 2025, atmospheric methane concentrations continued to rise. The IEA estimates that more than 85 million tonnes of fossil-fuel methane in 2025 came from the 10 biggest emitters: China, US, Russia, Iran, Turkmenistan, India, Venezuela, Indonesia, Kazakhstan and Iraq. Together, they account for around 70% of global fossil fuel methane emissions. The methane intensity of oil and gas production, or emissions per unit of energy delivered, varies widely, with the best performers scoring more than 100 times better than the worst, according to IEA data. Norway has the lowest upstream intensity in the world, the IEA found, achieved through a national ban on non-emergency flaring and a tax on venting and flaring introduced in 2015. Producers in the Middle East, including Saudi Arabia and the United Arab Emirates, also perform relatively well, according to the report. Turkmenistan and Venezuela have by far the highest intensities, the result of ageing Soviet-era and decrepit state-run infrastructure operating with little regulatory oversight. Independent analysis from the Stop Methane Project at UCLA found Turkmenistan dominated the list of the 25 worst-emitting facilities globally in 2025, emitting a “mind-boggling” amount of methane experts say could be easily contained. If every country matched Norway’s methane emissions intensity, global oil and gas methane emissions would fall by more than 90%, the IEA found. “Action on methane is not a fight of any single actor and nobody can win it alone,” French environment minister Monique Barbut said at the Paris event. “We must be clear: the energy sector offers today the fastest and often the most cost-effective reductions.” COP presidents press for action The IEA report was previewed at a high-level event at the agency’s Paris headquarters last week, where the COP31 presidency, made up of Turkey and Australia, set out priorities for the November summit in Antalya. Laurent Fabius, the former French prime minister who shepherded the Paris Agreement at COP21, said methane should be a central focus in Turkey, where the UN Environment Programme is expected to release its annual Eye on Methane report. Last year’s edition, launched at COP30 in Belém, found current national commitments would cut global methane emissions by just 8% below 2020 levels by 2030, under a quarter of the pledge target. “Methane is the faster way of trying to diminish global warming,” Fabius said. “Progress has been made. Pledges do exist, efficient techniques too, but we know that it is not enough. Methane should be one of the stars of COP31.” Sharma also pressed the point on finance, which he said was still falling far short of what was needed. Global clean energy investment reached a record €2.3 trillion last year, but a third of what was needed by 2030. Only 10% had gone to hard-to-abate sectors, and more than 80% to East Asia, Europe and the United States. Excluding China, developing countries representing 30 to 35% of global emissions were not getting the finance they need, he said. “We’re still nowhere near the scale that we should be … If you want to transition away from fossil fuels, you need to provide the finance for people to do that,” Sharma said. “We need to make sure there’s grant support to help developing nations look at their regulatory regimes.” “There will be some people who will say, and they’ve said it in the past, that the COPs are not the place this nitty gritty discussion on finance. That’s wrong. That is totally wrong,” Sharma said. “It is absolutely the place where we ought to be having discussion about these details on finance.” Simon Stiell, the UN Climate Change Executive Secretary, framed the energy crisis triggered by the war in the Middle East as an argument for accelerating the transition itself, which would in turn cut methane at source by reducing demand for the fossil fuels that produce it. “Those who’ve fought to keep the world hooked on fossil fuels are inadvertently supercharging the global renewables boom,” Stiell said. “This latest fossil fuel cost crisis has made the economic logic of renewables impossible to ignore.” “Renewables offer safer, cheaper, cleaner energy that can’t be held captive by narrow shipping straits, or global conflicts,” Stiell said, adding that “slashing methane” should be one of the most urgent priorities of COP31 for its potential to deliver “fast climate benefits while saving money.” Clean cooking and the bioenergy gap Around 18 million tonnes of methane emissions in 2025 came from the roughly 2 billion people worldwide who cook on open fires or simple stoves burning wood, charcoal and agricultural residues, with serious consequences for human health and the environment. Nearly half of them live in sub-Saharan Africa, where four in five households have no access to clean cooking technology, according to data released at the IMF Spring Meetings. The smoke produced exposes mostly women and children to particulate matter and carbon monoxide, driving severe respiratory and cardiovascular disease. Cooking with solid fuels is linked to 815,000 premature deaths a year globally, and household air pollution from these fuels remains one of the leading environmental health risks worldwide. “Expanding access to clean cooking solutions, including liquefied petroleum gas, electricity, improved biomass stoves and clean biofuels, offers further scope to cut methane emissions while delivering substantial health, gender and economic benefits in communities most affected by traditional biomass use,” the report said. Clean cooking is one of the COP31 presidency’s stated priorities, alongside electrification, zero waste and finance, representatives of the presidency from Turkey and Australia said. “Electrification, clean cooking, zero waste and finance, these are things that we can all gather around,” said Australia’s ambassador Stephen Jones, deputising for the country’s COP31 negotiations president. Jones said the climate transition and the response to the energy crisis were the same fight. “The clean energy solution is the solution to the energy crisis that we are now engaged in,” he said. “Paris is working. But we have to work faster and put more effort in.” Image Credits: Clean Air Task Force , IEA, IEA . Big Tobacco is No Longer Selling Cigarettes – It Is Engineering Addiction 04/05/2026 Hans Henri P. Kluge The tobacco industry is using sophisticated marketing aimed at young people. Europe needs a more precise focus to address the tobacco industry’s “engineered architecture of addiction”, featuring flavoured tobacco and nicotine products with ever more sleek designs. As an early champion of global tobacco legislation, the region can reposition itself to lead again – including through updated European Union directives on tobacco product regulation, advertising and taxation. Twenty-one years ago, the WHO Framework Convention on Tobacco Control (FCTC), the world’s first global health treaty and one of the EU’s earliest major public-health commitments, entered into force. It has helped to drive a reduction in tobacco use, with over 120 million fewer people using tobacco worldwide and best-practice protections expanded to more than six billion people. As a new WHO/ Europe report, published last year to mark the treaty’s 20th anniversary, shows, its core principles remain relevant – perhaps even more so today, as new products and tobacco industry tactics disrupt public health progress in unprecedented ways. Tobacco remains one of the world’s most lethal health hazards, killing more than seven million people globally each year, including an estimated 1.6 million non-smokers who are exposed to second-hand smoke. The WHO’s European Region, with 53 member states, has the dubious distinction of being the world’s leader in tobacco use, as well as the global leader in growing e-cigarette use among youth. Tobacco use trends (2000-2030) The scale is stark: in 2024 alone, 173 million adults and four million adolescents aged 13-15 were tobacco users, alongside 31.4 million adults and 4.2 million adolescents using e-cigarettes. What is increasingly evident today is that the danger is no longer confined to tobacco itself. It has shifted toward the engineered architecture of addiction – products designed to attract new consumers, sustain dependence and undermine public health. Flavours, filters, and sleek designs for Gen Z and younger The tobacco industry is much more than harvesting, curing, or rolling leaves. It now has sophisticated products and advertising machinery built to capture attention, personalise user experience, stay one step ahead of regulation and hook consumers long before they ever touch a cigarette. The tobacco and nicotine industry now markets an expanding universe of products – from heated tobacco and e-cigarettes to “aromatic nose inhalers” and nicotine pouches. Most of these products contain nicotine in different forms and concentrations, flavours and all of them exploit desire, reward pathways and the psychological hooks of habit and dependence. If, in the last century, cigarettes were marketed by images of rugged masculinity and reassuring doctors, today’s new generation of tobacco and nicotine products is packaged in joyful, playful social media posts attuned to millennials, Gen Z and younger audiences. There is bright packaging, unboxing videos, or lifestyle clips that blur the line between advertising and entertainment. Many play along, click, like and share. New products are being designed to attract children and young adolescents, mimicking candies and toys. The strategy remains the same: to make nicotine and tobacco products look modern, harmless, and desirable. Much of this content is not presented as advertising at all. The addictive architecture of social media does the heavy lifting. Influencers trusted by millions of young followers may feature these products under the guise of authentic personal recommendations, while in reality contributing to the industry’s transnational marketing reach. Viral ads multiplied by trust is a very powerful combination that does much harm in the wrong hands. This concerns me personally. As a father of two daughters, I can see how important social media is for them. It gives the feeling of emotional connection, belonging, and significance. And this is true for me as well – I can feel social media influencing my worldview and my work at WHO/ Europe every day. Full implementation of Framework Convention on Tobacco Control One of the most striking findings in the WHO/ Europe report is that the most powerful tobacco-control measures are already known and proven to work, but their adoption and proper implementation at country-level is lacking. Since 2019, rates of adolescent e-cigarette use have increased in 22 of 25 EU countries reviewed, and in all of them, girls report higher use than boys. Tobacco use among women in the EU remains high and sharply contrasts with the global downward trend. This is in line with the findings of the European Commission’s latest evaluation of the EU tobacco control framework, which highlights the rapid rise of novel tobacco and nicotine products — especially among young people — as a key and growing challenge. All of this points to one conclusion: full implementation of the WHO FCTC is overdue. The EU’s existing directives – the Tobacco Products Directive, the Tobacco Advertising Directive, and the Tobacco Taxation Directive – must be updated and strengthened to deliver on the treaty’s commitments . Today’s major problems include uneven implementation, regulatory loopholes, and slow adaptation to new products and new realities of digital marketing –all influenced by the tobacco industry. A strong political commitment is necessary to overcome these challenges and change the trajectory of nicotine and tobacco use. Europe can lead once again By accelerating implementation, closing regulatory loopholes, modernizing legislative frameworks to address digital marketing, and applying effective price and tax measures, the EU can set a powerful global example and advance the vision of a Tobacco-Free Generation by 2040, an ambition set out in Europe’s Beating Cancer Plan, and later re-iterated in the EU Safe Hearts Plan. Twenty years on, the FCTC continues to provide a strong foundation, but today’s market realities call for its full implementation that is complemented by forward-looking measures. As an early architect and champion of the FCTC, the EU is uniquely positioned to lead once again – and this leadership will be most effective if exercised without delay, ensuring that policy not only keeps pace with, but anticipates, emerging products and industry tactics. Hans Henri Kluge is the regional director of the WHO/European Region. Image Credits: Filter, WHO, WHO. Landmark EU Vote Demands ‘Only Yes Means Yes’ Rape Law, Targeting Gaps in Survivor Care 01/05/2026 Felix Sassmannshausen Legislators Joanna Scheuring-Wielgus and Evin Incir present the parliament’s demand for a rape law based on an ‘only yes means yes’ principle. STRASBOURG – Amid a global backlash against sexual and reproductive rights, the European Parliament has taken a decisive stand by voting for a unified, human rights-based standard for sexual offences. This Europe-wide legislative push aims to overhaul the fragmented national laws that currently leave many survivors without access to justice or essential health support. The resolution formally urges the European Commission to draft binding laws that recognise rape is fundamentally defined by a lack of consent. This represents a stark departure from outdated national models that require victims to physically fight back or explicitly say no. Swedish lawmaker Evin Incir addresses the European Parliament. “It is both morally and legally unacceptable that women are not protected by ‘only yes means yes’ legislation across the EU,” leading lawmaker Evin Incir from the centre-left social democrats (S&D) declared following the plenary vote on Tuesday. Just hours earlier, the European Parliament had adopted a landmark report with 447 votes in favour, 160 votes against, and 43 abstentions, demanding a unified standard for sexual offences. The push for reform is driven by a societal reckoning, spurred by cases that have sparked international outrage, such as that of Gisèle Pelicot in France. During a high-profile 2024 trial, the public learned that Pelicot’s husband had covertly drugged and raped her over a decade, also inviting dozens of men to rape her while she was unconscious. Human rights baseline: only yes means yes Comparison between outdated force-based legal requirements and the Parliament’s proposed standard of affirmative, voluntary consent. At the core of the European debate is the push for an ‘only yes means yes’ principle to ensure that any sexual act without freely given consent is legally classified as a crime. While a clear verbal “yes” is the most direct method, legal experts emphasise that consent can be expressed in any voluntary and unambiguous way, meaning affirmative gestures or reciprocal actions, depending on the specific context of the relationship. Establishing legislation focused on the lack of consent is widely viewed as the necessary next step to implement the Istanbul Convention. Opened for signature in 2011 and ratified or acceded to by 39 parties, Article 36 of this comprehensive international treaty explicitly requires member states to criminalise all non-consensual sexual acts, setting a clear human rights baseline. A unified legal definition is essential for health policy, as it directly impacts how survivors access emergency contraception, trauma counselling, and forensic medical care. Recognising the health sector’s critical role in this recovery process, the WHO Regional Office for Europe provides health system baseline assessments to help stakeholders monitor member states’ compliance with the Istanbul Convention. The latest comprehensive EU gender-based violence survey reveals that a staggering 30.7% of women across the bloc have experienced physical or sexual violence, which aligns with global data. Crucially, 8.4% of women report being raped while under coercion or being unable to refuse, nearly double the 4.8% who experienced overt physical force. Despite this high prevalence, systemic barriers continue to suppress official reporting and hinder access to post-rape care. Only 13.9% of victims ever contact the police, frequently citing embarrassment, fear of retaliation, or a belief that law enforcement cannot help them as their primary reasons for silence. Acknowledging trauma and fear responses Neurobiological evidence from the Karolinska Institute shows 70% of survivors experience paralysis, supporting calls for an ‘only yes means yes’ approach. A critical aspect of focusing on the lack of consent involves officially recognising the physiological realities of trauma. Medical experts and victim advocates continuously stress that a lack of physical resistance does not equate to a voluntary agreement. Co-rapporteur Joanna Scheuring-Wielgus during the plenary debate. Legislators underscored the neurobiological “freeze” response, where a victim perceives overwhelming danger, and the body is rendered completely paralysed. “It’s important to understand that a victim may not always have the strength to fight, to say no,” Polish co-rapporteur Joanna Scheuring-Wielgus explained at the press conference. While some victims might actively fight back, others can also freeze or faint. A 2017 Swedish study from the Karolinska Institute found that 70% of sexual assault survivors experience significant “tonic immobility,” an involuntary, temporary state of motor inhibition triggered by intense fear. Current legal systems in several member states routinely dismiss cases where victims experienced this involuntary physiological paralysis, which the European Parliament notes causes severe secondary victimisation. Furthermore, victim support networks like Women Against Violence in Europe (WAVE) warn that failing to provide trauma-informed, gender-specific responses deters survivors from seeking essential medical and psychological support. Implementing laws based on an ‘only yes means yes’ principle would mandate that judges and law enforcement officials understand these complex trauma responses. Policy analysts argue this shift is vital for building trust in public institutions and ensuring that victims feel safe enough to access specialised healthcare services. Fractured legal landscape leaves survivors vulnerable German legal barriers create a stark gap between rising rape reports and actual criminal convictions. The contrast between different national models highlights why European lawmakers are demanding unified rules. In Germany, the current framework dictates that a victim must signal refusal, meaning perpetrators often escape conviction if the victim remains passive due to fear. According to recently published data from the Federal Criminal Police, 14,454 rapes were reported in Germany in 2025, an 8.5% increase that officials attribute primarily to a growing willingness among victims to come forward. However, the consequences of the current legal framework are still reflected in extremely low conviction rates, with the women’s rights organisation Terre des Femmes estimating that only one in one hundred rapes ultimately results in a conviction. Legal practitioners, including the German Women Lawyers Association, argue that this standard protects perpetrators rather than victims by shifting the responsibility of communication onto the assaulted person. They maintain that establishing the lack of consent as the legal threshold is the necessary next step to enable more victims to seek justice. Conversely, countries such as Sweden and Spain have recently reformed their penal codes to ensure that sexual relations must be affirmatively agreed upon. While Sweden has already recorded a subsequent rise in convictions due to broadened evidence admissibility, monitors note that Spain’s groundbreaking 2022 law has yet to translate into similar statistical increases. Political tide is changing in Europe After tough negotiations, the European Parliament voted for a unified legal standard based on an ‘only yes means yes’ principle on Tuesday. The road to a unified standard has been fraught with conflict. During the 2024 negotiations for the EU’s first Directive on violence against women, a blocking minority led by France, Germany, and Hungary successfully stripped rape from the final text. Rapporteur Evin Incir reminded the public of the “unholy alliance” of leaders – including Viktor Orbán and Emmanuel Macron – who formed this blocking minority. These national leaders had argued that the European Union lacked the legal competence to harmonise criminal laws on sexual violence. Only US Votes Against Women’s Rights Document at UN Commission However, the political winds are shifting. Mounting public pressure has forced national governments to reconsider, with countries like France now actively revising their own criminal codes to align with an ‘only yes means yes’-based model. Despite the momentum, the proposal faces fierce opposition from far-right factions who frame the initiative as an ideological overreach. During the Strasbourg debate, an MEP from the Patriots for Europe group argued that “human relationships do not unfold through formalized steps or legal checklists,” claiming the law would amount to morally policing intimate desire. Other right-wing voices attempted to pivot the debate toward anti-immigrant narratives, suggesting lawmakers should “protect the streets, not the bedrooms”. Progressive lawmakers swiftly rejected this framing, citing data that proves the vast majority of sexual assaults are committed by perpetrators known to the victim, underscoring the systemic, domestic nature of the crisis. More than judicial reform needed The proposed European standard combines legal reform with mandatory education and trauma-informed training for law enforcement. Establishing the ‘only yes means yes’ principle as the legal threshold for rape demands a fundamental re-evaluation of how European societies view sexual availability and interpersonal power dynamics. The core premise is that sexual partners must actively communicate their desires and mutually negotiate the boundaries of their intimacy. However, reforming the penal code to reflect the lack of consent is only one part of the broader societal transformation envisioned by the European Parliament. Lawmakers are heavily emphasising the need for mandatory, comprehensive sexuality and relationship education across all member states. To ensure these legal reforms are effectively applied, parliamentarians are also demanding mandatory, trauma-sensitive education for law enforcement officers to prevent secondary victimisation during police investigations. “Why in 2026 should it be controversial that we demand that it should be mandatory for those who are working to support these women and girls who are victims?” rapporteur Incir asked, pointing to the tough negotiations with conservative co-legislators. The European Commission has signalled its readiness to support this cultural shift by mapping the current legal landscape across the Union to identify further legislative action. However, it could take years before an EU-wide law takes effect: after the Commission proposes a legal framework, the parliament and EU member states have to negotiate their positions and find a compromise. Image Credits: Felix Sassmannshausen/HPW. Energy Transition ‘Past Point of No Return,’ 57 Nations Declare at First Fossil Fuel Phase-Out Summit 01/05/2026 Stefan Anderson Coalition launches first sustained diplomatic push to phase out oil, gas and coal as war in the Middle East exposes the costs of fossil fuel dependence. The first international conference on phasing out the oil, gas and coal igniting the climate crisis ended with 57 governments representing every continent and a third of the global economy declaring the transition away from fossil fuels is now irreversible. “Actions taken to date prove that the energy transition is past its point of no return,” the coalition declared in its closing document, affirming all members were “ready to advance their transition away from fossil fuels.” The momentum is partly driven by concern for the planet, but also by a strategic desire for the energy independence that renewables could provide in an era of geopolitical instability – a case sharpened by the havoc the war in the Middle East was wreaking on the global economy as delegates gathered on Colombia’s Caribbean coast. “In a time that has been marked by fragmentation, that has been affected by war, by mistrust and the climate crisis, to sit here together and talk about the challenges, talk about the taboos, it’s a deep transformation of policy,” Irene Vélez Torres, Colombia’s environment minister and conference co-chair, said in her closing remarks in Santa Marta. Conference co-chairs Irene Vélez Torres, Colombia’s environment minister, and Stientje van Veldhoven, the Dutch climate minister, celebrate at the closing plenary. “When they look back at us from the future, they will remember that we were there, working on the challenges of our time,” Vélez Torres added. “That we decided not to focus on an economy built on war and destruction — we decided instead that it was necessary to prioritise life, security, certainty, sovereignty and solidarity.” The conference produced no binding commitments, no finance pledges, no promises of emissions cuts — that wasn’t the point. Instead, organisers pitched the summit as a “safe space” for countries already committed to phasing out fossil fuels to speak frankly. No negotiations, no consensus text to be watered down, no red lines passed down from governments to throw a wrench into discussions. A space free of the fossil fuel lobbyists who fill the corridors of UN climate summits by the thousands, both openly and embedded in petrostate delegations, often outnumbering full national delegation teams. “The fact we didn’t have negotiations here makes for such a different dynamic,” said Stientje van Veldhoven, the Dutch climate minister and co-chair alongside Vélez Torres. “The psychology of the Santa Marta process is something that we will definitely make sure to carry forward.” A coalition born of frustration Two weeks of negotiations in Belém, Brazil, failed to address a phase-out plan for coal, oil and gas as more than 100 nations blocked language on the fossil fuels at the root of the climate crisis. Three years on from the COP28 breakthrough in Dubai, where nearly 200 countries agreed to “transition away from fossil fuels,” efforts to translate the pledge into concrete action have hit a wall. Negotiations to agree a phase-out roadmap at COP30 in Brazil last November were torpedoed by a coalition of petrostates led by Saudi Arabia, which drew over half of the nations in attendance to its side in opposing the plan. The final text in Belém contained no reference to “fossil fuels” at all, a marked step backwards for the UN climate process. Without that failure, the Santa Marta conference would not exist. Conceived in the hours after COP30 collapsed, the new process was born of frustration with the gridlock of consensus-based UN climate diplomacy. But its architects stressed that it is meant to be complementary to mainstream COPs, not to replace them. “It’s very important that we agree on the fact that we want this conference, this process, to be like an accelerator for what we want to do in the context of UNFCCC,” van Veldhoven said, adding that the chairs have already been in touch with the COP31 presidency. Alongside government ministers, the conference included nearly 3,000 representatives of subnational governments, trade unions, scientists, civil society groups, Indigenous Peoples, women’s organisations and youth representatives, all named in the closing document as equal participants rather than observers, the title they hold in UN negotiations. “A new reality is taking shape: this is no longer a one-off moment, but the foundation of an ongoing international process dedicated to phasing out fossil fuels,” said Kumi Naidoo, president of the Fossil Fuel Treaty Initiative. “What is emerging is a process that can finally match climate diplomacy to the scale of the crisis.” Countries will attempt to carry the momentum forward at the next phase-out conference, confirmed in the closing hours to be held in 2027 on the Pacific island of Tuvalu and co-hosted by Ireland, pairing a wealthy European island with one across the globe at risk of disappearing under sea-level rise. “We are making history. We have proven, in the words of our youth, that another way is possible,” Tuvalu’s representative said. “The world is in a fossil fuel crisis, of climate breakdown, of conflict, of instability. But here in Santa Marta, we have planted a seed of solutions.” The tailwind from Hormuz Roughly a fifth of the world’s oil passes through the Strait of Hormuz, where wartime disruptions have driven prices to their highest level in years and exposed how much the global economy still depends on fossil fuels. Running through the conference was the war between Israel, the United States and Iran, which has disrupted shipping through the Strait of Hormuz, tightening gas supplies across Europe and Asia and skyrocketing oil prices to their highest level in years. On the same day delegates closed proceedings, US President Donald Trump told reporters Iran would have to “cry uncle” before he lifted what he called his “genius” blockade. Brent crude hit $126 a barrel hours later, approaching the spike that followed Russia’s invasion of Ukraine in 2022. For the three-quarters of the world that depends on fossil fuel imports, the message of the past five days was hard to miss: their energy costs, inflation rates, fiscal stability and the prices their citizens pay for food and fuel are tied to decisions made by a handful of leaders in Washington, Moscow and Riyadh – none of whom were in Santa Marta. The coalition’s closing document named the Hormuz crisis directly, calling the disruptions a demonstration “that reducing fossil fuel dependencies is critical” to “keep our planet livable, to safeguard energy security, and to build economic resilience to volatile fossil fuel markets.” “Destructive oil wars, widening fuel and food shocks, and a mounting climate crisis only bolster the conviction that breaking free from the fossil fuel system is not a matter of magical realism but of radical realism, in line with science and the law,” said Nikki Reisch, director of climate and energy at the Centre for International Environmental Law. Van Veldhoven framed the crisis as part of the case for moving faster. “If these countries significantly reduce their dependency on fossil fuels, it means they’ll be investing in their own economy instead of importing fossil fuels from abroad,” she told Bloomberg. “It means they’ll be investing in clean technologies, but it also means they’ll be shielding their economies against the kind of price shocks we’re seeing currently.” Santa Marta: Key outcomes from first summit on ‘transitioning away’ from fossil fuels | @daisydunnesci Read here: https://t.co/YGUgQR5BTg pic.twitter.com/1nZuILSPO7 — Carbon Brief (@CarbonBrief) May 1, 2026 France became the first major economy to act on that argument at scale during the conference, releasing a national roadmap to eliminate fossil fuels from its energy mix by 2050. The plan does not introduce new pledges but consolidates existing French climate and energy targets under a single explicit goal: ending the use of oil, gas and coal for energy purposes by 2050. Globally, the picture is mixed. Fossil fuels remain responsible for more than 75% of greenhouse gas emissions, but new renewable capacity in 2025 is nearly 50% higher than in 2023, and renewables are meeting nearly all new energy demand, according to the International Energy Agency. Investment in the energy transition reached a record $2.4 trillion in 2024, more than double 2019 levels, though it is concentrated in advanced economies and China, IRENA found. “This momentum is not yet enough to deliver the needed breakthrough,” said Bronwen Tucker, public finance lead at Oil Change International. “The richest polluting countries must take immediate action to accelerate their transitions at home and show up with meaningful international economic cooperation.” Coalition of the self-aware For all its ambition, the coalition openly admitted the limits of its own reach. The outcome document released in Santa Marta lays out in candid detail the shortcomings of the coalition in Colombia, and the distance all nations still have to go to achieve the transition away from fossil fuels. Chief among these admissions is the degree to which most nations in attendance continue to be dependent on oil, gas or coal for the public revenues that fund health, infrastructure and other government functions, and ensure energy security. Until governments find a way to replace that funding, walking away from fossil fuel production remains off the table. “The countries present in Santa Marta still have structural dependencies to overcome, including fiscal dependencies, debt constraints, the dependence of the financial architecture on fossil fuels,” the outcome paper states. “Transitioning away from fossil fuels is more than replacing one energy source with another … the transition itself is complex.” Many others simply do not have the financial headroom to invest in renewables due to looming debt payments and empty balance sheets. “We must confront economic dependence on fossil fuels that shape the realities we face,” Tuvalu’s delegate said. “Unsustainable debt, reliance on fossil fuel revenues, and a global financial system that was not built for us, and too often fails us.” The coalition also recognised the limits of its own power. While the alliance contains a meaningful contingent of major fossil fuel producers – Norway, Canada, Australia, the United Kingdom, Brazil, Mexico, Nigeria, Angola and Colombia itself – what it does not contain is a critical mass of global fossil fuel supply or demand. The 57 countries present make up about a fifth of global fossil fuel production, a third of oil and gas demand, and the same share of world economic output. The five biggest fossil fuel producers – the United States, China, Russia, India and Saudi Arabia – were all absent. Together, they control nearly half the world economy, and pump about 45% of the world’s oil, half its natural gas and three-quarters of its coal, far outstripping the heft of the Santa Marta coalition on all fronts. “We are here with an immense group, and yet it is still too small a group for what our ambition actually is,” van Veldhoven said. “Let’s make sure that we continue to drive this process as an open coalition. That means we have to ensure visibility of the outcomes and use that as an invitation to others to join us.” Rockstars to the rescue Attendees gather for the launch of the Science Panel for the Global Energy Transition (SPGET) in Santa Marta. A concrete outcome of the summit is the creation of a new scientific panel to advise nations on the practice and policy of the fossil fuel phase-out, an idea born in the halls of COP30, which Vélez Torres pitched as a sort of climate scientists’ Avengers team of “rock star academics”. “This panel not only repairs a historical debt of an organisation dedicated, finally and for the first time, to overcoming fossil fuels in the energy matrix,” she said, “it will also tell us about other types of challenges regarding the social and economic limitations of being able to carry out this transition as quickly as possible.” The Science Panel for the Global Energy Transition (SPGET) will unite over 100 scientists and academics to guide nations in policymaking and emissions pathway analysis with the goal of keeping the 1.5°C warming target enshrined in the Paris Agreement alive. The independent panel will focus on mapping policy options, green technologies and financial mechanisms that can be harnessed by countries to reduce emissions and fossil fuel dependence. Johan Rockström, director of the Potsdam Institute for Climate Impact Research and co-lead of SPGET, said it will operate as a “scientific service” to governments, helping them figure out the balance of energy supply and demand with a “scientifically aligned, just and orderly phase out of fossil fuels.” “[The panel] will also enable us to have feedback into the COP process so that we can keep the fossil fuel phase-out discussions in plenary at the COP meeting alive,” Rockström said. “Now is the moment to tip the scales, to not allow anymore that a few actors at the COP meetings always block the most important discussion of them all: the phase-out of coal, oil and gas.” The hard the work begins Delegates arrive for high-level ministerial sessions in Santa Marta, Colombia. The final agreement struck at Santa Marta establishes three “workstreams”: working groups of countries, experts and civil society that will meet between now and the next conference to develop policy options on the thorniest questions of the phase-out. The first will focus on national emissions roadmaps, taking specific aim at what Vélez Torres called the “punto ciego,” or blind spot, in the Paris Agreement: exported emissions. Under the Nationally Determined Contributions (NDCs) mandated in the Paris Accords, countries report emissions on a territorial basis, but not the emissions from fossil fuels they extract and sell to other countries. For major exporters, the effect on emissions calculations is enormous. Norway’s exported emissions from oil and gas are roughly ten times its territorial emissions. Saudi Arabia’s full emissions footprint rises to two and a half times its reported emissions, closing in on 5% of global CO2 on its own. “We are not making clear commitments about how we are going to control the emissions that are exported from producing countries,” said Vélez Torres, whose country, Colombia, sees its emissions more than double when its coal and oil exports are counted. “We want to be very clear, very honest about how to transition away from production as well.” Winding down production is one of the most complex questions in the phase-out debate. If demand falls first, producer countries face collapsing revenues and an economic crisis. If supply falls first, importers face energy shortages. A complementary workstream announced in Santa Marta, backed by the OECD, will look at how exporters and importers can coordinate their wind-downs so the two declines move in step, avoiding a scenario where one side pulls back faster than the other, leaving producers without buyers or importers without fuel before clean alternatives can fill the gap. Money traps, and future hopes Indigenous Peoples’ representatives played a central role in the Santa Marta phase-out talks. The final workstream, supported by the International Institute for Sustainable Development, takes on what the co-hosts called the three “traps” holding states back from moving faster on fossil fuel phase-outs: finance, debt and subsidies. It is, in many ways, the hardest of the three. Without alternative revenues lined up, governments cannot turn off the tap on production that pays their bills. The constraint tightens further as interest payments squeeze public budgets and credit ratings for developing nations render borrowing exceedingly expensive, leaving fossil fuel revenue indispensable and crowding out renewables investment. Then there are the subsidies. Governments worldwide handed roughly $1.3 trillion in direct support to fossil fuel producers and consumers in 2022 to keep pump and power prices low, according to the IMF, and as much as $7 trillion once the unpriced costs of pollution and climate damage are factored in. The direct figure alone is more than half the $2.4 trillion the world invested in the entire energy transition the same year, tilting the market against cheaper renewables as subsidies keep expensive fossil fuels price-competitive. In Ghana, the financial realities of fossil fuel dependence remain too steep to overcome, its delegate told the conference, despite the country supporting the phase-out goal. “In Ghana, fossil fuels remain deeply tied to government revenues that fund essential public services and to our broader energy systems,” he said. “We need a fossil fuel treaty that creates the necessary architecture for a just transition.” Ten-year-old Paula Pedro from Colombia speaks at the closing of the Santa Marta conference. That the coalition is willing to talk openly about the financial dependency at the heart of the phase-out is, for many participants, the most encouraging signal to come out of Santa Marta. Whether it can build bridges and expand its membership as the climate crisis accelerates is the question that will loom over COP31 in Antalya later this year, and in the run-up to Tuvalu in 2027. With the workstreams set and the next conference scheduled, it fell to a 10-year-old from Colombia to remind the room what the diplomacy was for. “Of the 12 million children we have in Colombia, eight out of ten of us are affected by fossil fuels and weather changes,” Paula Pedro, representing the Colombian children and youth coalition, told the assembly. “What we need, for the children, is that the people in this room do the math, but not only on paper, but accomplish change as a matter of fact.” “We’re not only the future,” Pedro said. “We are the present and beyond.” Image Credits: Colombian Environment Ministry, Colombian Environment Ministry, COP30, ColomColombian Environment Ministrybian Ministry o, Colombian Environment Ministry, Colombian Environment Ministry, Colombian Environment Ministry. Heartbroken Families Face Huge Structural Barriers When Trying to Prove Medical Negligence in India 01/05/2026 Arsalan Bukhari & Naila Tabassum Indian families face a huge struggle to get timely access to medical records of loved ones who have died in Indian health facilities, while the police can only lay a charge against a doctor if an independent medical expert first confirms negligence. NEW DELHI – India faces thousands of medical negligence cases every year, but structural problems make it extremely difficult for patients’ families to find out what has happened to their loved ones – let alone win compensation when treatment has been botched. “A shadow of death is looming over us,” Ashwini Bajaj, a Haryana-based businessman, told Health Policy Watch, recalling the treatment of his 24-year-old son, Deshbandhu, more than a year after his death. In December 2024, Deshbandhu, an MBA student at Punjab University and Bajaj’s only son, developed a fever that lasted more than two days. On 26 December, he visited a hospital near his university in Chandigarh, where he was prescribed medicines and given a series of tests, including a liver function test (LFT). By the time the results came out later that evening, Deshbandhu had returned to his parents’ home in Hisar, around 200 kilometres away. The next day, he went to a private hospital there, but his condition deteriorated rapidly. His oxygen saturation dropped to 65%, and doctors warned of acute liver failure. “We were told his condition was very critical and that the hospital did not have the resources to treat him,” Bajaj said. “We were asked to take him to a super-speciality hospital. It felt as if the ground beneath our feet had slipped away.” Deshbandhu was shifted to a major private hospital in Gurugram. “My son was there for over three weeks. His condition kept deteriorating. He went with jaundice, and he developed intestinal obstruction, kidney stress, and pneumonia,” Bajaj said. A few days after his 24th birthday, which was on 20 January 2025, Deshbandhu died. Bajaj says he has been unable to return to work. His case reflects broader systemic gaps in India’s healthcare system, where delays in critical care, weak referral systems, and limited transparency can have life-threatening consequences — and the lack of updated national data continues to hamper accountability. Transparency in treatment Deshbandhu Bajaj (24), a mountaineer and an MBA student who died in January 2025. His father, Ashwini Bajaj, alleges medical negligence. “Initially, I thought the doctors tried hard to save my child, but when I obtained all the medical reports, which took three to four months to obtain, I realised much time was lost before the actual treatment started,” Bajaj said. “When I made a day-by-day chart, I realised that, for at least four days, my son didn’t get the treatment he should have. “Every evening, I used to get payment requests promptly on my WhatsApp. If they could send payment requests, why can’t they share procedural updates the same way?” Rujhan Dhawan, a lawyer at the Punjab and Haryana High Court, told Health Policy Watch such opacity is a major barrier to accountability. “A patient, once admitted, is entirely dependent on the institution not only for treatment but also for truthful disclosure,” he said. “Critical information about procedures and complications is often not readily accessible to families.” Bajaj’s family spent over ₹30 lakh ($33,000) on treatment. He says he is not seeking compensation, but a legal framework that mandates transparency. Not an isolated case Deshbandhu’s case is not an isolated one. According to the 18th Annual MedLegal Review, 65,000 medical negligence cases were filed in India in 2025 alone. Radha Sharma (49), a resident of Rajasthan’s capital city Jaipur, died days after being given a TB drugs although she had been diagnosed with a liver-related illness. In Jaipar, around 270 kilometres from Gurugram, 55-year-old tax consultant Kishan Kumar Sharma is fighting a case linked to the death of his wife, Radha. On 3 March 2025, she developed mild jaundice and was admitted to a private hospital. A test suggested Budd-Chiari syndrome, a rare liver disorder. However, despite a negative tuberculosis test, Radha was prescribed the TB drug, Isoniazid, said Sharma. Isoniazid should not be prescribed to patients with liver disease who have bilirubin levels over 4 mg/dL, according to World Health Organization (WHO) guidelines. But Sharma says his wife’s liver disorder was overlooked. Radha’s condition deteriorated rapidly, and she died on 18 March. “I have a simple question,” Sharma said. “Why was my wife given Isoniazid? Was it part of any established protocol or something else?” The risks highlighted by such cases reflect a broader global problem. According to the WHO, an estimated 138 million patients are harmed every year due to unsafe medical care. Lack of dedicated investigative body Nishant Bharihoke, an advocate at the Delhi High Court who specialises in medical negligence cases, told Health Policy Watch the core issue lies in the absence of a dedicated independent investigative framework. “India does not have a dedicated body specifically tasked with investigating deaths or serious injuries caused by medical negligence,” he said. “When a patient dies, and the family suspects wrongdoing, there is no authority whose sole function is to find out what happened.” Complaints are typically routed through State Medical Councils, which may form inquiry committees. Their decisions can be appealed to the National Medical Commission, but Bharihoke argues that the system is structurally limited. “The National Medical Commission’s primary mandate is to regulate medical education. Its disciplinary board has no independent investigators and no power to enter hospitals and examine evidence,” he said. He also pointed to a legal loophole: since these proceedings are not strictly judicial, false statements made before such bodies do not result in perjury charges. For families like Bajaj’s and Sharma’s, he said, this gap deepens the sense of injustice. When cases turn criminal Simran Chhabra (21), a resident of Gurugram and MA student at Amity University, was suffering from a simple cough and cold. She died within minutes of being administered an intravenous injection. The family is fighting a medical negligence case in a Gurugram court. The gap becomes even wider when negligence overlaps with criminal allegations. One such case is the death of 21-year-old Simran Chhabra. On 21 January 2023, she visited a private hospital in Gurugram with symptoms of cough and cold. According to a prescription her brother, Sourabh Chhabra, shared with Health Policy Watch, she was administered an intravenous injection of Dynapar. This is usually used to treat pain and inflammation associated with arthritis or after surgery. “As soon as the injection was fully administered, Simran collapsed on the bed and froth began coming out of her mouth,” Sourabh said. “Everything happened within minutes. I had no time to understand what was going on.” She was referred to another hospital, where she was declared dead. According to Bharihoke, the family’s legal representative, the doctor later claimed that multiple emergency interventions were carried out, including five additional injections and cardiopulmonary resuscitation (CPR), using drugs typically administered in cases of severe allergic reactions. However, the post-mortem report reviewed by Health Policy Watch raises questions. It records only two puncture marks on her body, and there is no mention of a cannula (an intravenous tube) being used. If multiple injections were administered, the family asks why there is no corresponding physical evidence. In this case, they argue, the medical account and post-mortem findings do not align. “Forget conviction or arrest, even registering an FIR in such cases often requires court intervention,” Bharihoke said. A FIR is a First Information Report (FIR) in Indian medical negligence cases, a formal document prepared by police under Section 154 of the Criminal Procedure Code upon receiving information about alleged criminal negligence. Absence of a legal framework Several structural barriers insulate medical health practitioners against negligence cases, according to legal experts. “In India, police usually cannot even register a case against a doctor unless an independent medical expert first confirms negligence,” Bharihoke told Health Policy Watch. “In most cases, doctors are reluctant to give such opinions, especially against their peers.” The challenge is compounded by access to evidence. Hospitals retain control over key records, case files, prescriptions, nursing notes, and CCTV footage while families often receive only partial or delayed documentation. India also lacks a statutory system guaranteeing timely access to medical records for patients and their families. There is no clear legal mandate requiring investigators to immediately secure hospital evidence. Tanvi Dubey, a Supreme Court lawyer, told Health Policy Watch the legal framework itself raises the bar for accountability. “Criminal liability in medical negligence cases is limited to gross negligence, not simple errors of judgment,” Dubey said. “This significantly narrows the scope for prosecution.” Even initiating an investigation can be delayed: “Authorities are allowed to conduct preliminary inquiries before registering a case, which often means waiting for medical opinions and slows the process.” Dubey also pointed to the continued reliance on what is known in Indian law as the “Bolam principle,” where a doctor’s actions are judged against a body of medical opinion. “This makes expert testimony central. Unless a complainant can produce strong contrary evidence, it becomes very difficult to establish negligence,” she said. While multiple legal remedies exist, including consumer courts, civil litigation, and disciplinary proceedings, Dubey noted that each comes with limitations. “Criminal prosecution is rare, civil cases are slow and evidence-heavy, and disciplinary proceedings do not always ensure compensation or thorough fact-finding,” she said. Compared with Western peers, India faces two major policy gaps in patients’ treatment: the absence of a national electronic medical record (EMR) system, and the lack of a digital system connecting labs directly to the consulting doctor. Currently, India doesn’t have a mandatory EMR policy applicable to healthcare organisations. Even today, prescriptions, clinical notes, and drug administration records are still handwritten in the majority of hospitals and almost all smaller clinics. This makes them more vulnerable to tampering, loss and destruction. The absence of a nationwide electronic medical record system adds another layer of opacity. In many facilities, records remain handwritten and vulnerable to alteration; a gap Bharihoke alleges was evident in Simran’s case. Urgent reform is necessary India’s Minister of Health Jagat Prakash Nadda. Legal experts are calling on authorities to establish an independent statutory body to investigate medical negligence. Only families with the financial means and emotional capacity to pursue long legal battles are able to take up medical negligence cases. For many others, the burden becomes too heavy to carry. While the rules may appear neutral on paper, experts say their impact is deeply unequal. Legal and policy experts argue that the most urgent reform is structural, particularly the creation of an independent statutory body tasked solely with investigating patient safety incidents, particularly in cases involving death, permanent disability, or serious injury. Such a body should have the authority to enter hospital premises, access medical records, secure CCTV footage, and record statements. Its findings should be made public, while the evidence it collects remains protected from use in criminal or disciplinary proceedings. In England, the Health Services Safety Investigations Body (HSSIB), established in 2023, follows this approach by conducting independent investigations into patient safety incidents. Globally, different systems offer alternative approaches to accountability. In the United States, oversight is spread across multiple layers: state medical boards regulate conduct, a national database tracks malpractice records, hospitals report serious incidents, and patients can pursue civil litigation. China follows a three-tier system, allowing patients to first negotiate with hospitals, then seek mediation, and finally pursue civil lawsuits. In parts of Europe, including France and the Nordic countries, no-fault compensation systems allow patients to receive compensation without proving negligence, making the process more accessible and less adversarial. Aviation and rail safety investigations have long operated on similar principles, focusing on systemic failures rather than individual blame. For India, experts say the lesson is clear. Accountability frameworks do not have to rely solely on litigation. A system built on independent investigation, timely access to evidence, and patient-centric redress could help provide answers to families like the Bajajs and Sharmas. Image Credits: César Badilla Miranda/ Unsplash, Felix Sassmannshausen. No Pandemic Agreement Annex by World Health Assembly, Says Civil Society 30/04/2026 Kerry Cullinan (Left to right from top) Third World Network’s moderator and speakers Lauren Paremoer, KP Gopakumar and Tamara Prisenburg form AIDS Healthcare Foundation. The final missing piece of the Pandemic Agreement – a pathogen access and benefit-sharing (PABS) system – is unlikely to be agreed on by the World Health Assembly (WHA) later this month. This was the view of civil society observers of the talks taking place at the World Health Organisation (WHO) headquarters in Geneva, who briefed the media on Thursday. The sixth round of talks is scheduled to end late on Friday night (1 May). Earlier in the week, WHO Director General Dr Tedros Adhanom Ghebreyesus told a Geneva media briefing that “key differences remain on key issues”. “I still see a common will to reach consensus, which means I continue to believe there is a way to reach consensus,” Tedros added. Although the notion of a “hybrid” PABS system is being discussed informally, its proponent, the European Union (EU), has not presented any formal text, Third World Network’s (TWN) KM Gopakumar told the media briefing, which was hosted by TWN and the AIDS Healthcare Foundation. While Brazil and Botswana have apparently indicated that they might support a hybrid or “blended” compromise, the Africa Group is opposed to it, according to the civil society representatives. WHO member states are negotiating how to share both information about dangerous pathogens and some of the “benefits” that manufacturers may develop from that information – namely, vaccines, therapeutics and diagnostics (VTDs). The “hybrid” or “blended” proposal is a mix of mandatory and voluntary measures for sharing pathogen information and any benefits that flow from this information. It de-links information-sharing and benefit-sharing. Gopakumar said that, in terms of the blended agreements, countries that shared pathogens “will have the freedom to choose to attach certain conditions for sharing the data and the sample, including benefit sharing requirements” or share without any conditions. Kill the efficiency Shifting the choice to individual countries would undermine the efficiency of a single PABS system as users would need to negotiate with the individual countries instead of through a centralised system, he argued. “If you have a hybrid system, first of all, it kills the efficiency [of a single system], and second, it’s going to debase the access and benefit sharing norms set by the international instruments like the Convention on Biological Diversity and the Nagoya Protocol. Any attempt to dilute benefit-sharing obligations would be a “disaster” for equity, said AHF’s Tamara Prisenberg. Lauren Paremoer of the People’s Health Movement said that the blended model introduces “a two-track system for accessing pathogens” that violates access and benefit-sharing on an “equal footing” specified in Article 12 of the Pandemic Agreement. One track would allow anonymous users to access pathogen data without upfront commitments to benefit-sharing or legally binding contracts. The other was in line with Article 12, permitting access to pathogens through databases and laboratories that would require users to register and commit to specified benefit-sharing. Earlier in the day, the Intergovernmental Working Group (IGWG) briefed civil society on text-based negotiations, but very little of the text they shared had been “greened” to show agreement. EXCLUSIVE: WHO Opens Nominations for Next Director General; Germany May Advance Former Merkel Aide, Helge Braun 30/04/2026 Felix Sassmannshausen, Elaine Ruth Fletcher & Editorial team WHO DG Dr Tedros Adhanom Ghebreyesus issued a call for nominations for the DG elections. He recently travelled to Berlin, where he met with high-level politicians and the WHO’s Pandemic Intelligence team. As the World Health Organization (WHO) formally opens the nomination process for the next Director-General, Germany now appears likely to propose Helge Braun, Chief of Staff in former Chancellor Angela Merkel’s government, according to Berlin insiders. But after slashing its global health budget, sources question whether a German candidate can win wide support from other WHO member states. WHO Director-General Dr Tedros Adhanom Ghebreyesus has formally issued a call to WHO member states for nominations to the DG elections, scheduled for May 2027, in an invitation sent on 24 April to all WHO member states. WHO confirmed this in an email to Health Policy Watch. The invitations had been sent via private letters to countries’ Geneva missions. The period in which member states may nominate candidates will now run for six months, until 24 September. Contenders who have until now remained in the shadows are expected to begin coming forward publicly with their candidacies at the World Health Assembly in May. From the German perspective, Berlin wants its financial weight reflected in executive influence at the multilateral level as the largest global health donor following the US withdrawal from the WHO in January 2025. The withdrawal, combined with the US non-payment of dues owed, thrust WHO into a budget crisis, prompting layoffs of about 25% of the workforce in the past year. German Foreign Ministry neither confirms nor denies The German Foreign Ministry, formally responsible for the nomination, declined to confirm or comment on Braun’s potential candidacy when responding to a query by Health Policy Watch. Germany’s other potential candidates include the contested former Health Minister Karl Lauterbach and the lesser-known Paul Zubeil. In contrast, Braun’s dual profile as an accomplished politician, skilled financial manager, and trained physician and researcher who successfully built cross-party bridges offers a distinct advantage. But he is little known outside of Germany. Bridge-builder with executive and medical expertise Former Chair of the influential German Budget Committee, Helge Braun (right), and former French Chair of the Finance Committee, Claude Raynal (left), in the Bundestag. The current WHO leadership landscape demands a candidate capable of managing deep institutional fractures and uniting a divided global community. Despite him being largely unknown in the international community, Germany could be expected to emphasise Braun’s extensive fiscal and crisis management experience in any candidacy it mounts. As ‘Head of the Chancellery’, effectively Chief of Staff, in Angela Merkel’s last term as Chancellor, from 2018 to 2021, Braun operated at the nexus of scientific advice and political implementation during the COVID-19 pandemic, notably comparing the Chancellery to an intensive care unit where acute problems must be solved. Between 2021 and 2025, Braun then chaired the powerful Budget Committee of the German Bundestag (Parliament), overseeing the distribution and management of hundreds of billions of Euros with strict discipline This profound understanding of macroeconomic management, coupled with his pragmatic defence of Germany’s controversial debt ceiling alongside crisis-driven special funds, makes him an attractive prospect for donor nations currently demanding more financial accountability and restructuring at WHO in Geneva. Serving as a central mediator across government ministries, Braun built a reputation as a highly pragmatic problem solver whose past domestic political affiliations will not necessarily dictate his future approach to global health governance. This pragmatism complements his longstanding political advocacy for research into infectious diseases like Ebola and malaria. And unlike many career politicians, Braun’s foundational expertise lies in medicine, having worked for years as an intensive care physician and anaesthesiologist. He returned to these roots in April 2025 by assuming the presidency of the University of Lübeck, an institution renowned for its focus on life sciences and artificial intelligence. Why the candidacy might spark concerns WHO member states are currently negotiating a pathogen access and benefit-sharing (PABS) system in Geneva. While Braun championed early interventions and massive digitisation projects in his role as Merkel’s Head of the Chancellery during the COVID pandemic, severe bureaucratic delays hampered the rollout of vaccination campaigns and testing strategies. This tarnished his crisis management legacy just as he exited the federal government. His domestic political capital suffered further damage during the December 2021 Christian Democratic Union leadership election, where he lost heavily to conservative rival Friedrich Merz, now Chancellor. Party members largely rejected Braun as an establishment candidate, perceiving him as too closely aligned with the moderate legacy of former Chancellor Angela Merkel. Additionally, it is questionable whether Braun would wield the necessary diplomatic connections and familiarity with foreign health systems to be effective on Day One of a term as WHO head. The Director-General must immediately command trust and authority on the international stage, particularly when dealing with health ministries and stakeholders in the Global South. Most notably, the German government opposed the release of COVID-19 vaccine patents during his tenure, drawing sharp criticism from international health equity advocates. Defending this refusal in May 2021, Braun wrote in a guest article for the German newspaper Die Zeit that “patent protection as a driver of innovation is not the problem in this crisis, but an essential foundation for its solution.” In the Global South, this track record could thus reinforce the perception that Germany defends pharmaceutical interests over equitable technology transfer – especially in the face of current PABS Annex negotiations. Recent reports from Tagesspiegel Background indicating that the former minister was approached by Germany’s Association of Research-Based Pharmaceutical Companies to become their next president, when the post becomes vacant at the end of 2026, might further fuel these concerns. Finally, Germany has been cutting back its Official Development Assistance (ODA) in general, including contributions to the World Health Organization, where it has historically been the largest member state donor after the United States. On Wednesday, the Merz government announced its 2027 budget plans with further ODA cuts following last year’s drastic 17% reductions. The likelihood of Germany fulfilling its original 2024 financial pledge to WHO for the current biennium (2026-27) also remains in doubt. “They can put forward a candidate, but I don’t think it’s going to get a lot of traction from other member states,” said one informed WHO source. “At a time when Germany is reducing global health funding to member states, I don’t think they can go ahead and claim the top seat.” Step back and support allied candidates? Braun served as Head of Chancellery under then German Chancellor Angela Merkel, seen here with WHO Director General Dr Tedros in Berlin in 2021. Furthermore, domestic opinion remains highly divided on mounting a campaign amidst the geopolitical strains on Chancellor Friedrich Merz’s coalition and Tedros has reportedly urged Germany to back allied candidates instead. At the same time, the desire to seize more leadership in the UN system remains strong after Germany’s failed previous attempt to secure the top role at the UN High Commissioner for Refugees in 2025. Currently, Germany is also pushing for another attempt at a UN Security Council seat. Should Germany put forward a candidate, Foreign Minister Johann Wadephul, who will make the final decision, also faces a stark choice between Braun and the better-known Karl Lauterbach, as well as Paul Zubeil with his strong international health and technical background. Advancing a WHO outsider like Braun against established public health veterans is a highly calculated risk for Berlin, which must first convince other European countries to rally behind him. In case Berlin formally nominates Braun, the success of his candidacy will depend entirely on how effectively the government can reframe his perceived lack of field experience and global networks as delivery on fresh, badly needed fiscal expertise and perspectives. Grappling with WHO’s funding crisis As the race for the next Director-General opens for formal nominations, the names of over a dozen high-profile potential candidates are still circulating – from Indonesia to the United Kingdom. Want to Become the Next WHO Director-General? Get in Line And the list is still growing. Among the newer names being floated is that of Dr Hanan Mohamed al-Kuwari, who served as Qatar’s Minister of Public Health until November 2024 and chaired the 153rd Session of the WHO Executive Board. Before joining the Hamad Medical Corporation in 1996, where she ultimately rose to managing director, al-Kuwari worked for Reuters and as a freelance health reporter. Holding a PhD in healthcare management from Brunel University and bringing early career experience from the WHO, she represents a highly networked voice from the Arab world, celebrated for her crisis resilience and for shaping the WHO’s recent global work programme. Dr Maria Neira, former WHO Director of Climate, Environment and Health Another candidate who has been mentioned is Spain’s Dr Maria Neira, who recently retired from WHO as the director of Climate, Environment and Health. An iconic spokesperson for the climate, environment and health movement, Neira is known as a telegenic personality and adroit politically. As a young medical doctor, she worked in emergency relief in Latin America and Africa, and later served as Spain’s Vice Minister of Health and Consumer Affairs as well as President of the Spanish Food Safety and Nutrition Agency. However, Spain also recently decided to nominate a candidate to head the UN Food and Agriculture Organization (FAO), when Qu Dongyu’s second term as Director General ends in July 2027, leaving doubts about whether it would want to mount yet another campaign, in parallel. Continuing decline in ODA and global health aid Drastic ODA cuts and reduced global health funding leave vulnerable populations in precarious conditions worldwide. Whoever is elected will have to continue grappling with the continuing long-term declines in donor-driven ODA, and particularly global health aid – directly to countries and to WHO. While WHO 2026-2027 $4.2 billion base budget is now 85% financed, according to Tedros’ comments on Wednesday, declines in ODA continue to cast uncertainty on how the remaining $630 million gap will be filled. It’s unlikely that the $260.6 million in assessed US contributions still due for years 2024-2025, before the withdrawal became official in January, will ever be repaid, conceded WHO’s Tedros at a Geneva press briefing on Wednesday. “We’re hoping to get the money, but no signals yet,” Tedros told journalists, adding: “No signals means maybe we may not be able to get the money. The likelihood could be not getting the money.” “We’re looking at nontraditional donors. We’re looking at international financial institutions and other ways to mobilize that 15%,” Tedros said, in terms of filling that gap. “It’s not that we won’t go to the traditional donors, but I think we’re expanding that donor base.” This article has been edited to reflect additional information regarding Dr Hanan Mohamed al-Kuwari’s early career as a freelance journalist. Image Credits: X/Dr Tedros, Deutscher Bundestag/Leon Kügeler, European Commission. 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Big Tobacco is No Longer Selling Cigarettes – It Is Engineering Addiction 04/05/2026 Hans Henri P. Kluge The tobacco industry is using sophisticated marketing aimed at young people. Europe needs a more precise focus to address the tobacco industry’s “engineered architecture of addiction”, featuring flavoured tobacco and nicotine products with ever more sleek designs. As an early champion of global tobacco legislation, the region can reposition itself to lead again – including through updated European Union directives on tobacco product regulation, advertising and taxation. Twenty-one years ago, the WHO Framework Convention on Tobacco Control (FCTC), the world’s first global health treaty and one of the EU’s earliest major public-health commitments, entered into force. It has helped to drive a reduction in tobacco use, with over 120 million fewer people using tobacco worldwide and best-practice protections expanded to more than six billion people. As a new WHO/ Europe report, published last year to mark the treaty’s 20th anniversary, shows, its core principles remain relevant – perhaps even more so today, as new products and tobacco industry tactics disrupt public health progress in unprecedented ways. Tobacco remains one of the world’s most lethal health hazards, killing more than seven million people globally each year, including an estimated 1.6 million non-smokers who are exposed to second-hand smoke. The WHO’s European Region, with 53 member states, has the dubious distinction of being the world’s leader in tobacco use, as well as the global leader in growing e-cigarette use among youth. Tobacco use trends (2000-2030) The scale is stark: in 2024 alone, 173 million adults and four million adolescents aged 13-15 were tobacco users, alongside 31.4 million adults and 4.2 million adolescents using e-cigarettes. What is increasingly evident today is that the danger is no longer confined to tobacco itself. It has shifted toward the engineered architecture of addiction – products designed to attract new consumers, sustain dependence and undermine public health. Flavours, filters, and sleek designs for Gen Z and younger The tobacco industry is much more than harvesting, curing, or rolling leaves. It now has sophisticated products and advertising machinery built to capture attention, personalise user experience, stay one step ahead of regulation and hook consumers long before they ever touch a cigarette. The tobacco and nicotine industry now markets an expanding universe of products – from heated tobacco and e-cigarettes to “aromatic nose inhalers” and nicotine pouches. Most of these products contain nicotine in different forms and concentrations, flavours and all of them exploit desire, reward pathways and the psychological hooks of habit and dependence. If, in the last century, cigarettes were marketed by images of rugged masculinity and reassuring doctors, today’s new generation of tobacco and nicotine products is packaged in joyful, playful social media posts attuned to millennials, Gen Z and younger audiences. There is bright packaging, unboxing videos, or lifestyle clips that blur the line between advertising and entertainment. Many play along, click, like and share. New products are being designed to attract children and young adolescents, mimicking candies and toys. The strategy remains the same: to make nicotine and tobacco products look modern, harmless, and desirable. Much of this content is not presented as advertising at all. The addictive architecture of social media does the heavy lifting. Influencers trusted by millions of young followers may feature these products under the guise of authentic personal recommendations, while in reality contributing to the industry’s transnational marketing reach. Viral ads multiplied by trust is a very powerful combination that does much harm in the wrong hands. This concerns me personally. As a father of two daughters, I can see how important social media is for them. It gives the feeling of emotional connection, belonging, and significance. And this is true for me as well – I can feel social media influencing my worldview and my work at WHO/ Europe every day. Full implementation of Framework Convention on Tobacco Control One of the most striking findings in the WHO/ Europe report is that the most powerful tobacco-control measures are already known and proven to work, but their adoption and proper implementation at country-level is lacking. Since 2019, rates of adolescent e-cigarette use have increased in 22 of 25 EU countries reviewed, and in all of them, girls report higher use than boys. Tobacco use among women in the EU remains high and sharply contrasts with the global downward trend. This is in line with the findings of the European Commission’s latest evaluation of the EU tobacco control framework, which highlights the rapid rise of novel tobacco and nicotine products — especially among young people — as a key and growing challenge. All of this points to one conclusion: full implementation of the WHO FCTC is overdue. The EU’s existing directives – the Tobacco Products Directive, the Tobacco Advertising Directive, and the Tobacco Taxation Directive – must be updated and strengthened to deliver on the treaty’s commitments . Today’s major problems include uneven implementation, regulatory loopholes, and slow adaptation to new products and new realities of digital marketing –all influenced by the tobacco industry. A strong political commitment is necessary to overcome these challenges and change the trajectory of nicotine and tobacco use. Europe can lead once again By accelerating implementation, closing regulatory loopholes, modernizing legislative frameworks to address digital marketing, and applying effective price and tax measures, the EU can set a powerful global example and advance the vision of a Tobacco-Free Generation by 2040, an ambition set out in Europe’s Beating Cancer Plan, and later re-iterated in the EU Safe Hearts Plan. Twenty years on, the FCTC continues to provide a strong foundation, but today’s market realities call for its full implementation that is complemented by forward-looking measures. As an early architect and champion of the FCTC, the EU is uniquely positioned to lead once again – and this leadership will be most effective if exercised without delay, ensuring that policy not only keeps pace with, but anticipates, emerging products and industry tactics. Hans Henri Kluge is the regional director of the WHO/European Region. Image Credits: Filter, WHO, WHO. Landmark EU Vote Demands ‘Only Yes Means Yes’ Rape Law, Targeting Gaps in Survivor Care 01/05/2026 Felix Sassmannshausen Legislators Joanna Scheuring-Wielgus and Evin Incir present the parliament’s demand for a rape law based on an ‘only yes means yes’ principle. STRASBOURG – Amid a global backlash against sexual and reproductive rights, the European Parliament has taken a decisive stand by voting for a unified, human rights-based standard for sexual offences. This Europe-wide legislative push aims to overhaul the fragmented national laws that currently leave many survivors without access to justice or essential health support. The resolution formally urges the European Commission to draft binding laws that recognise rape is fundamentally defined by a lack of consent. This represents a stark departure from outdated national models that require victims to physically fight back or explicitly say no. Swedish lawmaker Evin Incir addresses the European Parliament. “It is both morally and legally unacceptable that women are not protected by ‘only yes means yes’ legislation across the EU,” leading lawmaker Evin Incir from the centre-left social democrats (S&D) declared following the plenary vote on Tuesday. Just hours earlier, the European Parliament had adopted a landmark report with 447 votes in favour, 160 votes against, and 43 abstentions, demanding a unified standard for sexual offences. The push for reform is driven by a societal reckoning, spurred by cases that have sparked international outrage, such as that of Gisèle Pelicot in France. During a high-profile 2024 trial, the public learned that Pelicot’s husband had covertly drugged and raped her over a decade, also inviting dozens of men to rape her while she was unconscious. Human rights baseline: only yes means yes Comparison between outdated force-based legal requirements and the Parliament’s proposed standard of affirmative, voluntary consent. At the core of the European debate is the push for an ‘only yes means yes’ principle to ensure that any sexual act without freely given consent is legally classified as a crime. While a clear verbal “yes” is the most direct method, legal experts emphasise that consent can be expressed in any voluntary and unambiguous way, meaning affirmative gestures or reciprocal actions, depending on the specific context of the relationship. Establishing legislation focused on the lack of consent is widely viewed as the necessary next step to implement the Istanbul Convention. Opened for signature in 2011 and ratified or acceded to by 39 parties, Article 36 of this comprehensive international treaty explicitly requires member states to criminalise all non-consensual sexual acts, setting a clear human rights baseline. A unified legal definition is essential for health policy, as it directly impacts how survivors access emergency contraception, trauma counselling, and forensic medical care. Recognising the health sector’s critical role in this recovery process, the WHO Regional Office for Europe provides health system baseline assessments to help stakeholders monitor member states’ compliance with the Istanbul Convention. The latest comprehensive EU gender-based violence survey reveals that a staggering 30.7% of women across the bloc have experienced physical or sexual violence, which aligns with global data. Crucially, 8.4% of women report being raped while under coercion or being unable to refuse, nearly double the 4.8% who experienced overt physical force. Despite this high prevalence, systemic barriers continue to suppress official reporting and hinder access to post-rape care. Only 13.9% of victims ever contact the police, frequently citing embarrassment, fear of retaliation, or a belief that law enforcement cannot help them as their primary reasons for silence. Acknowledging trauma and fear responses Neurobiological evidence from the Karolinska Institute shows 70% of survivors experience paralysis, supporting calls for an ‘only yes means yes’ approach. A critical aspect of focusing on the lack of consent involves officially recognising the physiological realities of trauma. Medical experts and victim advocates continuously stress that a lack of physical resistance does not equate to a voluntary agreement. Co-rapporteur Joanna Scheuring-Wielgus during the plenary debate. Legislators underscored the neurobiological “freeze” response, where a victim perceives overwhelming danger, and the body is rendered completely paralysed. “It’s important to understand that a victim may not always have the strength to fight, to say no,” Polish co-rapporteur Joanna Scheuring-Wielgus explained at the press conference. While some victims might actively fight back, others can also freeze or faint. A 2017 Swedish study from the Karolinska Institute found that 70% of sexual assault survivors experience significant “tonic immobility,” an involuntary, temporary state of motor inhibition triggered by intense fear. Current legal systems in several member states routinely dismiss cases where victims experienced this involuntary physiological paralysis, which the European Parliament notes causes severe secondary victimisation. Furthermore, victim support networks like Women Against Violence in Europe (WAVE) warn that failing to provide trauma-informed, gender-specific responses deters survivors from seeking essential medical and psychological support. Implementing laws based on an ‘only yes means yes’ principle would mandate that judges and law enforcement officials understand these complex trauma responses. Policy analysts argue this shift is vital for building trust in public institutions and ensuring that victims feel safe enough to access specialised healthcare services. Fractured legal landscape leaves survivors vulnerable German legal barriers create a stark gap between rising rape reports and actual criminal convictions. The contrast between different national models highlights why European lawmakers are demanding unified rules. In Germany, the current framework dictates that a victim must signal refusal, meaning perpetrators often escape conviction if the victim remains passive due to fear. According to recently published data from the Federal Criminal Police, 14,454 rapes were reported in Germany in 2025, an 8.5% increase that officials attribute primarily to a growing willingness among victims to come forward. However, the consequences of the current legal framework are still reflected in extremely low conviction rates, with the women’s rights organisation Terre des Femmes estimating that only one in one hundred rapes ultimately results in a conviction. Legal practitioners, including the German Women Lawyers Association, argue that this standard protects perpetrators rather than victims by shifting the responsibility of communication onto the assaulted person. They maintain that establishing the lack of consent as the legal threshold is the necessary next step to enable more victims to seek justice. Conversely, countries such as Sweden and Spain have recently reformed their penal codes to ensure that sexual relations must be affirmatively agreed upon. While Sweden has already recorded a subsequent rise in convictions due to broadened evidence admissibility, monitors note that Spain’s groundbreaking 2022 law has yet to translate into similar statistical increases. Political tide is changing in Europe After tough negotiations, the European Parliament voted for a unified legal standard based on an ‘only yes means yes’ principle on Tuesday. The road to a unified standard has been fraught with conflict. During the 2024 negotiations for the EU’s first Directive on violence against women, a blocking minority led by France, Germany, and Hungary successfully stripped rape from the final text. Rapporteur Evin Incir reminded the public of the “unholy alliance” of leaders – including Viktor Orbán and Emmanuel Macron – who formed this blocking minority. These national leaders had argued that the European Union lacked the legal competence to harmonise criminal laws on sexual violence. Only US Votes Against Women’s Rights Document at UN Commission However, the political winds are shifting. Mounting public pressure has forced national governments to reconsider, with countries like France now actively revising their own criminal codes to align with an ‘only yes means yes’-based model. Despite the momentum, the proposal faces fierce opposition from far-right factions who frame the initiative as an ideological overreach. During the Strasbourg debate, an MEP from the Patriots for Europe group argued that “human relationships do not unfold through formalized steps or legal checklists,” claiming the law would amount to morally policing intimate desire. Other right-wing voices attempted to pivot the debate toward anti-immigrant narratives, suggesting lawmakers should “protect the streets, not the bedrooms”. Progressive lawmakers swiftly rejected this framing, citing data that proves the vast majority of sexual assaults are committed by perpetrators known to the victim, underscoring the systemic, domestic nature of the crisis. More than judicial reform needed The proposed European standard combines legal reform with mandatory education and trauma-informed training for law enforcement. Establishing the ‘only yes means yes’ principle as the legal threshold for rape demands a fundamental re-evaluation of how European societies view sexual availability and interpersonal power dynamics. The core premise is that sexual partners must actively communicate their desires and mutually negotiate the boundaries of their intimacy. However, reforming the penal code to reflect the lack of consent is only one part of the broader societal transformation envisioned by the European Parliament. Lawmakers are heavily emphasising the need for mandatory, comprehensive sexuality and relationship education across all member states. To ensure these legal reforms are effectively applied, parliamentarians are also demanding mandatory, trauma-sensitive education for law enforcement officers to prevent secondary victimisation during police investigations. “Why in 2026 should it be controversial that we demand that it should be mandatory for those who are working to support these women and girls who are victims?” rapporteur Incir asked, pointing to the tough negotiations with conservative co-legislators. The European Commission has signalled its readiness to support this cultural shift by mapping the current legal landscape across the Union to identify further legislative action. However, it could take years before an EU-wide law takes effect: after the Commission proposes a legal framework, the parliament and EU member states have to negotiate their positions and find a compromise. Image Credits: Felix Sassmannshausen/HPW. Energy Transition ‘Past Point of No Return,’ 57 Nations Declare at First Fossil Fuel Phase-Out Summit 01/05/2026 Stefan Anderson Coalition launches first sustained diplomatic push to phase out oil, gas and coal as war in the Middle East exposes the costs of fossil fuel dependence. The first international conference on phasing out the oil, gas and coal igniting the climate crisis ended with 57 governments representing every continent and a third of the global economy declaring the transition away from fossil fuels is now irreversible. “Actions taken to date prove that the energy transition is past its point of no return,” the coalition declared in its closing document, affirming all members were “ready to advance their transition away from fossil fuels.” The momentum is partly driven by concern for the planet, but also by a strategic desire for the energy independence that renewables could provide in an era of geopolitical instability – a case sharpened by the havoc the war in the Middle East was wreaking on the global economy as delegates gathered on Colombia’s Caribbean coast. “In a time that has been marked by fragmentation, that has been affected by war, by mistrust and the climate crisis, to sit here together and talk about the challenges, talk about the taboos, it’s a deep transformation of policy,” Irene Vélez Torres, Colombia’s environment minister and conference co-chair, said in her closing remarks in Santa Marta. Conference co-chairs Irene Vélez Torres, Colombia’s environment minister, and Stientje van Veldhoven, the Dutch climate minister, celebrate at the closing plenary. “When they look back at us from the future, they will remember that we were there, working on the challenges of our time,” Vélez Torres added. “That we decided not to focus on an economy built on war and destruction — we decided instead that it was necessary to prioritise life, security, certainty, sovereignty and solidarity.” The conference produced no binding commitments, no finance pledges, no promises of emissions cuts — that wasn’t the point. Instead, organisers pitched the summit as a “safe space” for countries already committed to phasing out fossil fuels to speak frankly. No negotiations, no consensus text to be watered down, no red lines passed down from governments to throw a wrench into discussions. A space free of the fossil fuel lobbyists who fill the corridors of UN climate summits by the thousands, both openly and embedded in petrostate delegations, often outnumbering full national delegation teams. “The fact we didn’t have negotiations here makes for such a different dynamic,” said Stientje van Veldhoven, the Dutch climate minister and co-chair alongside Vélez Torres. “The psychology of the Santa Marta process is something that we will definitely make sure to carry forward.” A coalition born of frustration Two weeks of negotiations in Belém, Brazil, failed to address a phase-out plan for coal, oil and gas as more than 100 nations blocked language on the fossil fuels at the root of the climate crisis. Three years on from the COP28 breakthrough in Dubai, where nearly 200 countries agreed to “transition away from fossil fuels,” efforts to translate the pledge into concrete action have hit a wall. Negotiations to agree a phase-out roadmap at COP30 in Brazil last November were torpedoed by a coalition of petrostates led by Saudi Arabia, which drew over half of the nations in attendance to its side in opposing the plan. The final text in Belém contained no reference to “fossil fuels” at all, a marked step backwards for the UN climate process. Without that failure, the Santa Marta conference would not exist. Conceived in the hours after COP30 collapsed, the new process was born of frustration with the gridlock of consensus-based UN climate diplomacy. But its architects stressed that it is meant to be complementary to mainstream COPs, not to replace them. “It’s very important that we agree on the fact that we want this conference, this process, to be like an accelerator for what we want to do in the context of UNFCCC,” van Veldhoven said, adding that the chairs have already been in touch with the COP31 presidency. Alongside government ministers, the conference included nearly 3,000 representatives of subnational governments, trade unions, scientists, civil society groups, Indigenous Peoples, women’s organisations and youth representatives, all named in the closing document as equal participants rather than observers, the title they hold in UN negotiations. “A new reality is taking shape: this is no longer a one-off moment, but the foundation of an ongoing international process dedicated to phasing out fossil fuels,” said Kumi Naidoo, president of the Fossil Fuel Treaty Initiative. “What is emerging is a process that can finally match climate diplomacy to the scale of the crisis.” Countries will attempt to carry the momentum forward at the next phase-out conference, confirmed in the closing hours to be held in 2027 on the Pacific island of Tuvalu and co-hosted by Ireland, pairing a wealthy European island with one across the globe at risk of disappearing under sea-level rise. “We are making history. We have proven, in the words of our youth, that another way is possible,” Tuvalu’s representative said. “The world is in a fossil fuel crisis, of climate breakdown, of conflict, of instability. But here in Santa Marta, we have planted a seed of solutions.” The tailwind from Hormuz Roughly a fifth of the world’s oil passes through the Strait of Hormuz, where wartime disruptions have driven prices to their highest level in years and exposed how much the global economy still depends on fossil fuels. Running through the conference was the war between Israel, the United States and Iran, which has disrupted shipping through the Strait of Hormuz, tightening gas supplies across Europe and Asia and skyrocketing oil prices to their highest level in years. On the same day delegates closed proceedings, US President Donald Trump told reporters Iran would have to “cry uncle” before he lifted what he called his “genius” blockade. Brent crude hit $126 a barrel hours later, approaching the spike that followed Russia’s invasion of Ukraine in 2022. For the three-quarters of the world that depends on fossil fuel imports, the message of the past five days was hard to miss: their energy costs, inflation rates, fiscal stability and the prices their citizens pay for food and fuel are tied to decisions made by a handful of leaders in Washington, Moscow and Riyadh – none of whom were in Santa Marta. The coalition’s closing document named the Hormuz crisis directly, calling the disruptions a demonstration “that reducing fossil fuel dependencies is critical” to “keep our planet livable, to safeguard energy security, and to build economic resilience to volatile fossil fuel markets.” “Destructive oil wars, widening fuel and food shocks, and a mounting climate crisis only bolster the conviction that breaking free from the fossil fuel system is not a matter of magical realism but of radical realism, in line with science and the law,” said Nikki Reisch, director of climate and energy at the Centre for International Environmental Law. Van Veldhoven framed the crisis as part of the case for moving faster. “If these countries significantly reduce their dependency on fossil fuels, it means they’ll be investing in their own economy instead of importing fossil fuels from abroad,” she told Bloomberg. “It means they’ll be investing in clean technologies, but it also means they’ll be shielding their economies against the kind of price shocks we’re seeing currently.” Santa Marta: Key outcomes from first summit on ‘transitioning away’ from fossil fuels | @daisydunnesci Read here: https://t.co/YGUgQR5BTg pic.twitter.com/1nZuILSPO7 — Carbon Brief (@CarbonBrief) May 1, 2026 France became the first major economy to act on that argument at scale during the conference, releasing a national roadmap to eliminate fossil fuels from its energy mix by 2050. The plan does not introduce new pledges but consolidates existing French climate and energy targets under a single explicit goal: ending the use of oil, gas and coal for energy purposes by 2050. Globally, the picture is mixed. Fossil fuels remain responsible for more than 75% of greenhouse gas emissions, but new renewable capacity in 2025 is nearly 50% higher than in 2023, and renewables are meeting nearly all new energy demand, according to the International Energy Agency. Investment in the energy transition reached a record $2.4 trillion in 2024, more than double 2019 levels, though it is concentrated in advanced economies and China, IRENA found. “This momentum is not yet enough to deliver the needed breakthrough,” said Bronwen Tucker, public finance lead at Oil Change International. “The richest polluting countries must take immediate action to accelerate their transitions at home and show up with meaningful international economic cooperation.” Coalition of the self-aware For all its ambition, the coalition openly admitted the limits of its own reach. The outcome document released in Santa Marta lays out in candid detail the shortcomings of the coalition in Colombia, and the distance all nations still have to go to achieve the transition away from fossil fuels. Chief among these admissions is the degree to which most nations in attendance continue to be dependent on oil, gas or coal for the public revenues that fund health, infrastructure and other government functions, and ensure energy security. Until governments find a way to replace that funding, walking away from fossil fuel production remains off the table. “The countries present in Santa Marta still have structural dependencies to overcome, including fiscal dependencies, debt constraints, the dependence of the financial architecture on fossil fuels,” the outcome paper states. “Transitioning away from fossil fuels is more than replacing one energy source with another … the transition itself is complex.” Many others simply do not have the financial headroom to invest in renewables due to looming debt payments and empty balance sheets. “We must confront economic dependence on fossil fuels that shape the realities we face,” Tuvalu’s delegate said. “Unsustainable debt, reliance on fossil fuel revenues, and a global financial system that was not built for us, and too often fails us.” The coalition also recognised the limits of its own power. While the alliance contains a meaningful contingent of major fossil fuel producers – Norway, Canada, Australia, the United Kingdom, Brazil, Mexico, Nigeria, Angola and Colombia itself – what it does not contain is a critical mass of global fossil fuel supply or demand. The 57 countries present make up about a fifth of global fossil fuel production, a third of oil and gas demand, and the same share of world economic output. The five biggest fossil fuel producers – the United States, China, Russia, India and Saudi Arabia – were all absent. Together, they control nearly half the world economy, and pump about 45% of the world’s oil, half its natural gas and three-quarters of its coal, far outstripping the heft of the Santa Marta coalition on all fronts. “We are here with an immense group, and yet it is still too small a group for what our ambition actually is,” van Veldhoven said. “Let’s make sure that we continue to drive this process as an open coalition. That means we have to ensure visibility of the outcomes and use that as an invitation to others to join us.” Rockstars to the rescue Attendees gather for the launch of the Science Panel for the Global Energy Transition (SPGET) in Santa Marta. A concrete outcome of the summit is the creation of a new scientific panel to advise nations on the practice and policy of the fossil fuel phase-out, an idea born in the halls of COP30, which Vélez Torres pitched as a sort of climate scientists’ Avengers team of “rock star academics”. “This panel not only repairs a historical debt of an organisation dedicated, finally and for the first time, to overcoming fossil fuels in the energy matrix,” she said, “it will also tell us about other types of challenges regarding the social and economic limitations of being able to carry out this transition as quickly as possible.” The Science Panel for the Global Energy Transition (SPGET) will unite over 100 scientists and academics to guide nations in policymaking and emissions pathway analysis with the goal of keeping the 1.5°C warming target enshrined in the Paris Agreement alive. The independent panel will focus on mapping policy options, green technologies and financial mechanisms that can be harnessed by countries to reduce emissions and fossil fuel dependence. Johan Rockström, director of the Potsdam Institute for Climate Impact Research and co-lead of SPGET, said it will operate as a “scientific service” to governments, helping them figure out the balance of energy supply and demand with a “scientifically aligned, just and orderly phase out of fossil fuels.” “[The panel] will also enable us to have feedback into the COP process so that we can keep the fossil fuel phase-out discussions in plenary at the COP meeting alive,” Rockström said. “Now is the moment to tip the scales, to not allow anymore that a few actors at the COP meetings always block the most important discussion of them all: the phase-out of coal, oil and gas.” The hard the work begins Delegates arrive for high-level ministerial sessions in Santa Marta, Colombia. The final agreement struck at Santa Marta establishes three “workstreams”: working groups of countries, experts and civil society that will meet between now and the next conference to develop policy options on the thorniest questions of the phase-out. The first will focus on national emissions roadmaps, taking specific aim at what Vélez Torres called the “punto ciego,” or blind spot, in the Paris Agreement: exported emissions. Under the Nationally Determined Contributions (NDCs) mandated in the Paris Accords, countries report emissions on a territorial basis, but not the emissions from fossil fuels they extract and sell to other countries. For major exporters, the effect on emissions calculations is enormous. Norway’s exported emissions from oil and gas are roughly ten times its territorial emissions. Saudi Arabia’s full emissions footprint rises to two and a half times its reported emissions, closing in on 5% of global CO2 on its own. “We are not making clear commitments about how we are going to control the emissions that are exported from producing countries,” said Vélez Torres, whose country, Colombia, sees its emissions more than double when its coal and oil exports are counted. “We want to be very clear, very honest about how to transition away from production as well.” Winding down production is one of the most complex questions in the phase-out debate. If demand falls first, producer countries face collapsing revenues and an economic crisis. If supply falls first, importers face energy shortages. A complementary workstream announced in Santa Marta, backed by the OECD, will look at how exporters and importers can coordinate their wind-downs so the two declines move in step, avoiding a scenario where one side pulls back faster than the other, leaving producers without buyers or importers without fuel before clean alternatives can fill the gap. Money traps, and future hopes Indigenous Peoples’ representatives played a central role in the Santa Marta phase-out talks. The final workstream, supported by the International Institute for Sustainable Development, takes on what the co-hosts called the three “traps” holding states back from moving faster on fossil fuel phase-outs: finance, debt and subsidies. It is, in many ways, the hardest of the three. Without alternative revenues lined up, governments cannot turn off the tap on production that pays their bills. The constraint tightens further as interest payments squeeze public budgets and credit ratings for developing nations render borrowing exceedingly expensive, leaving fossil fuel revenue indispensable and crowding out renewables investment. Then there are the subsidies. Governments worldwide handed roughly $1.3 trillion in direct support to fossil fuel producers and consumers in 2022 to keep pump and power prices low, according to the IMF, and as much as $7 trillion once the unpriced costs of pollution and climate damage are factored in. The direct figure alone is more than half the $2.4 trillion the world invested in the entire energy transition the same year, tilting the market against cheaper renewables as subsidies keep expensive fossil fuels price-competitive. In Ghana, the financial realities of fossil fuel dependence remain too steep to overcome, its delegate told the conference, despite the country supporting the phase-out goal. “In Ghana, fossil fuels remain deeply tied to government revenues that fund essential public services and to our broader energy systems,” he said. “We need a fossil fuel treaty that creates the necessary architecture for a just transition.” Ten-year-old Paula Pedro from Colombia speaks at the closing of the Santa Marta conference. That the coalition is willing to talk openly about the financial dependency at the heart of the phase-out is, for many participants, the most encouraging signal to come out of Santa Marta. Whether it can build bridges and expand its membership as the climate crisis accelerates is the question that will loom over COP31 in Antalya later this year, and in the run-up to Tuvalu in 2027. With the workstreams set and the next conference scheduled, it fell to a 10-year-old from Colombia to remind the room what the diplomacy was for. “Of the 12 million children we have in Colombia, eight out of ten of us are affected by fossil fuels and weather changes,” Paula Pedro, representing the Colombian children and youth coalition, told the assembly. “What we need, for the children, is that the people in this room do the math, but not only on paper, but accomplish change as a matter of fact.” “We’re not only the future,” Pedro said. “We are the present and beyond.” Image Credits: Colombian Environment Ministry, Colombian Environment Ministry, COP30, ColomColombian Environment Ministrybian Ministry o, Colombian Environment Ministry, Colombian Environment Ministry, Colombian Environment Ministry. Heartbroken Families Face Huge Structural Barriers When Trying to Prove Medical Negligence in India 01/05/2026 Arsalan Bukhari & Naila Tabassum Indian families face a huge struggle to get timely access to medical records of loved ones who have died in Indian health facilities, while the police can only lay a charge against a doctor if an independent medical expert first confirms negligence. NEW DELHI – India faces thousands of medical negligence cases every year, but structural problems make it extremely difficult for patients’ families to find out what has happened to their loved ones – let alone win compensation when treatment has been botched. “A shadow of death is looming over us,” Ashwini Bajaj, a Haryana-based businessman, told Health Policy Watch, recalling the treatment of his 24-year-old son, Deshbandhu, more than a year after his death. In December 2024, Deshbandhu, an MBA student at Punjab University and Bajaj’s only son, developed a fever that lasted more than two days. On 26 December, he visited a hospital near his university in Chandigarh, where he was prescribed medicines and given a series of tests, including a liver function test (LFT). By the time the results came out later that evening, Deshbandhu had returned to his parents’ home in Hisar, around 200 kilometres away. The next day, he went to a private hospital there, but his condition deteriorated rapidly. His oxygen saturation dropped to 65%, and doctors warned of acute liver failure. “We were told his condition was very critical and that the hospital did not have the resources to treat him,” Bajaj said. “We were asked to take him to a super-speciality hospital. It felt as if the ground beneath our feet had slipped away.” Deshbandhu was shifted to a major private hospital in Gurugram. “My son was there for over three weeks. His condition kept deteriorating. He went with jaundice, and he developed intestinal obstruction, kidney stress, and pneumonia,” Bajaj said. A few days after his 24th birthday, which was on 20 January 2025, Deshbandhu died. Bajaj says he has been unable to return to work. His case reflects broader systemic gaps in India’s healthcare system, where delays in critical care, weak referral systems, and limited transparency can have life-threatening consequences — and the lack of updated national data continues to hamper accountability. Transparency in treatment Deshbandhu Bajaj (24), a mountaineer and an MBA student who died in January 2025. His father, Ashwini Bajaj, alleges medical negligence. “Initially, I thought the doctors tried hard to save my child, but when I obtained all the medical reports, which took three to four months to obtain, I realised much time was lost before the actual treatment started,” Bajaj said. “When I made a day-by-day chart, I realised that, for at least four days, my son didn’t get the treatment he should have. “Every evening, I used to get payment requests promptly on my WhatsApp. If they could send payment requests, why can’t they share procedural updates the same way?” Rujhan Dhawan, a lawyer at the Punjab and Haryana High Court, told Health Policy Watch such opacity is a major barrier to accountability. “A patient, once admitted, is entirely dependent on the institution not only for treatment but also for truthful disclosure,” he said. “Critical information about procedures and complications is often not readily accessible to families.” Bajaj’s family spent over ₹30 lakh ($33,000) on treatment. He says he is not seeking compensation, but a legal framework that mandates transparency. Not an isolated case Deshbandhu’s case is not an isolated one. According to the 18th Annual MedLegal Review, 65,000 medical negligence cases were filed in India in 2025 alone. Radha Sharma (49), a resident of Rajasthan’s capital city Jaipur, died days after being given a TB drugs although she had been diagnosed with a liver-related illness. In Jaipar, around 270 kilometres from Gurugram, 55-year-old tax consultant Kishan Kumar Sharma is fighting a case linked to the death of his wife, Radha. On 3 March 2025, she developed mild jaundice and was admitted to a private hospital. A test suggested Budd-Chiari syndrome, a rare liver disorder. However, despite a negative tuberculosis test, Radha was prescribed the TB drug, Isoniazid, said Sharma. Isoniazid should not be prescribed to patients with liver disease who have bilirubin levels over 4 mg/dL, according to World Health Organization (WHO) guidelines. But Sharma says his wife’s liver disorder was overlooked. Radha’s condition deteriorated rapidly, and she died on 18 March. “I have a simple question,” Sharma said. “Why was my wife given Isoniazid? Was it part of any established protocol or something else?” The risks highlighted by such cases reflect a broader global problem. According to the WHO, an estimated 138 million patients are harmed every year due to unsafe medical care. Lack of dedicated investigative body Nishant Bharihoke, an advocate at the Delhi High Court who specialises in medical negligence cases, told Health Policy Watch the core issue lies in the absence of a dedicated independent investigative framework. “India does not have a dedicated body specifically tasked with investigating deaths or serious injuries caused by medical negligence,” he said. “When a patient dies, and the family suspects wrongdoing, there is no authority whose sole function is to find out what happened.” Complaints are typically routed through State Medical Councils, which may form inquiry committees. Their decisions can be appealed to the National Medical Commission, but Bharihoke argues that the system is structurally limited. “The National Medical Commission’s primary mandate is to regulate medical education. Its disciplinary board has no independent investigators and no power to enter hospitals and examine evidence,” he said. He also pointed to a legal loophole: since these proceedings are not strictly judicial, false statements made before such bodies do not result in perjury charges. For families like Bajaj’s and Sharma’s, he said, this gap deepens the sense of injustice. When cases turn criminal Simran Chhabra (21), a resident of Gurugram and MA student at Amity University, was suffering from a simple cough and cold. She died within minutes of being administered an intravenous injection. The family is fighting a medical negligence case in a Gurugram court. The gap becomes even wider when negligence overlaps with criminal allegations. One such case is the death of 21-year-old Simran Chhabra. On 21 January 2023, she visited a private hospital in Gurugram with symptoms of cough and cold. According to a prescription her brother, Sourabh Chhabra, shared with Health Policy Watch, she was administered an intravenous injection of Dynapar. This is usually used to treat pain and inflammation associated with arthritis or after surgery. “As soon as the injection was fully administered, Simran collapsed on the bed and froth began coming out of her mouth,” Sourabh said. “Everything happened within minutes. I had no time to understand what was going on.” She was referred to another hospital, where she was declared dead. According to Bharihoke, the family’s legal representative, the doctor later claimed that multiple emergency interventions were carried out, including five additional injections and cardiopulmonary resuscitation (CPR), using drugs typically administered in cases of severe allergic reactions. However, the post-mortem report reviewed by Health Policy Watch raises questions. It records only two puncture marks on her body, and there is no mention of a cannula (an intravenous tube) being used. If multiple injections were administered, the family asks why there is no corresponding physical evidence. In this case, they argue, the medical account and post-mortem findings do not align. “Forget conviction or arrest, even registering an FIR in such cases often requires court intervention,” Bharihoke said. A FIR is a First Information Report (FIR) in Indian medical negligence cases, a formal document prepared by police under Section 154 of the Criminal Procedure Code upon receiving information about alleged criminal negligence. Absence of a legal framework Several structural barriers insulate medical health practitioners against negligence cases, according to legal experts. “In India, police usually cannot even register a case against a doctor unless an independent medical expert first confirms negligence,” Bharihoke told Health Policy Watch. “In most cases, doctors are reluctant to give such opinions, especially against their peers.” The challenge is compounded by access to evidence. Hospitals retain control over key records, case files, prescriptions, nursing notes, and CCTV footage while families often receive only partial or delayed documentation. India also lacks a statutory system guaranteeing timely access to medical records for patients and their families. There is no clear legal mandate requiring investigators to immediately secure hospital evidence. Tanvi Dubey, a Supreme Court lawyer, told Health Policy Watch the legal framework itself raises the bar for accountability. “Criminal liability in medical negligence cases is limited to gross negligence, not simple errors of judgment,” Dubey said. “This significantly narrows the scope for prosecution.” Even initiating an investigation can be delayed: “Authorities are allowed to conduct preliminary inquiries before registering a case, which often means waiting for medical opinions and slows the process.” Dubey also pointed to the continued reliance on what is known in Indian law as the “Bolam principle,” where a doctor’s actions are judged against a body of medical opinion. “This makes expert testimony central. Unless a complainant can produce strong contrary evidence, it becomes very difficult to establish negligence,” she said. While multiple legal remedies exist, including consumer courts, civil litigation, and disciplinary proceedings, Dubey noted that each comes with limitations. “Criminal prosecution is rare, civil cases are slow and evidence-heavy, and disciplinary proceedings do not always ensure compensation or thorough fact-finding,” she said. Compared with Western peers, India faces two major policy gaps in patients’ treatment: the absence of a national electronic medical record (EMR) system, and the lack of a digital system connecting labs directly to the consulting doctor. Currently, India doesn’t have a mandatory EMR policy applicable to healthcare organisations. Even today, prescriptions, clinical notes, and drug administration records are still handwritten in the majority of hospitals and almost all smaller clinics. This makes them more vulnerable to tampering, loss and destruction. The absence of a nationwide electronic medical record system adds another layer of opacity. In many facilities, records remain handwritten and vulnerable to alteration; a gap Bharihoke alleges was evident in Simran’s case. Urgent reform is necessary India’s Minister of Health Jagat Prakash Nadda. Legal experts are calling on authorities to establish an independent statutory body to investigate medical negligence. Only families with the financial means and emotional capacity to pursue long legal battles are able to take up medical negligence cases. For many others, the burden becomes too heavy to carry. While the rules may appear neutral on paper, experts say their impact is deeply unequal. Legal and policy experts argue that the most urgent reform is structural, particularly the creation of an independent statutory body tasked solely with investigating patient safety incidents, particularly in cases involving death, permanent disability, or serious injury. Such a body should have the authority to enter hospital premises, access medical records, secure CCTV footage, and record statements. Its findings should be made public, while the evidence it collects remains protected from use in criminal or disciplinary proceedings. In England, the Health Services Safety Investigations Body (HSSIB), established in 2023, follows this approach by conducting independent investigations into patient safety incidents. Globally, different systems offer alternative approaches to accountability. In the United States, oversight is spread across multiple layers: state medical boards regulate conduct, a national database tracks malpractice records, hospitals report serious incidents, and patients can pursue civil litigation. China follows a three-tier system, allowing patients to first negotiate with hospitals, then seek mediation, and finally pursue civil lawsuits. In parts of Europe, including France and the Nordic countries, no-fault compensation systems allow patients to receive compensation without proving negligence, making the process more accessible and less adversarial. Aviation and rail safety investigations have long operated on similar principles, focusing on systemic failures rather than individual blame. For India, experts say the lesson is clear. Accountability frameworks do not have to rely solely on litigation. A system built on independent investigation, timely access to evidence, and patient-centric redress could help provide answers to families like the Bajajs and Sharmas. Image Credits: César Badilla Miranda/ Unsplash, Felix Sassmannshausen. No Pandemic Agreement Annex by World Health Assembly, Says Civil Society 30/04/2026 Kerry Cullinan (Left to right from top) Third World Network’s moderator and speakers Lauren Paremoer, KP Gopakumar and Tamara Prisenburg form AIDS Healthcare Foundation. The final missing piece of the Pandemic Agreement – a pathogen access and benefit-sharing (PABS) system – is unlikely to be agreed on by the World Health Assembly (WHA) later this month. This was the view of civil society observers of the talks taking place at the World Health Organisation (WHO) headquarters in Geneva, who briefed the media on Thursday. The sixth round of talks is scheduled to end late on Friday night (1 May). Earlier in the week, WHO Director General Dr Tedros Adhanom Ghebreyesus told a Geneva media briefing that “key differences remain on key issues”. “I still see a common will to reach consensus, which means I continue to believe there is a way to reach consensus,” Tedros added. Although the notion of a “hybrid” PABS system is being discussed informally, its proponent, the European Union (EU), has not presented any formal text, Third World Network’s (TWN) KM Gopakumar told the media briefing, which was hosted by TWN and the AIDS Healthcare Foundation. While Brazil and Botswana have apparently indicated that they might support a hybrid or “blended” compromise, the Africa Group is opposed to it, according to the civil society representatives. WHO member states are negotiating how to share both information about dangerous pathogens and some of the “benefits” that manufacturers may develop from that information – namely, vaccines, therapeutics and diagnostics (VTDs). The “hybrid” or “blended” proposal is a mix of mandatory and voluntary measures for sharing pathogen information and any benefits that flow from this information. It de-links information-sharing and benefit-sharing. Gopakumar said that, in terms of the blended agreements, countries that shared pathogens “will have the freedom to choose to attach certain conditions for sharing the data and the sample, including benefit sharing requirements” or share without any conditions. Kill the efficiency Shifting the choice to individual countries would undermine the efficiency of a single PABS system as users would need to negotiate with the individual countries instead of through a centralised system, he argued. “If you have a hybrid system, first of all, it kills the efficiency [of a single system], and second, it’s going to debase the access and benefit sharing norms set by the international instruments like the Convention on Biological Diversity and the Nagoya Protocol. Any attempt to dilute benefit-sharing obligations would be a “disaster” for equity, said AHF’s Tamara Prisenberg. Lauren Paremoer of the People’s Health Movement said that the blended model introduces “a two-track system for accessing pathogens” that violates access and benefit-sharing on an “equal footing” specified in Article 12 of the Pandemic Agreement. One track would allow anonymous users to access pathogen data without upfront commitments to benefit-sharing or legally binding contracts. The other was in line with Article 12, permitting access to pathogens through databases and laboratories that would require users to register and commit to specified benefit-sharing. Earlier in the day, the Intergovernmental Working Group (IGWG) briefed civil society on text-based negotiations, but very little of the text they shared had been “greened” to show agreement. EXCLUSIVE: WHO Opens Nominations for Next Director General; Germany May Advance Former Merkel Aide, Helge Braun 30/04/2026 Felix Sassmannshausen, Elaine Ruth Fletcher & Editorial team WHO DG Dr Tedros Adhanom Ghebreyesus issued a call for nominations for the DG elections. He recently travelled to Berlin, where he met with high-level politicians and the WHO’s Pandemic Intelligence team. As the World Health Organization (WHO) formally opens the nomination process for the next Director-General, Germany now appears likely to propose Helge Braun, Chief of Staff in former Chancellor Angela Merkel’s government, according to Berlin insiders. But after slashing its global health budget, sources question whether a German candidate can win wide support from other WHO member states. WHO Director-General Dr Tedros Adhanom Ghebreyesus has formally issued a call to WHO member states for nominations to the DG elections, scheduled for May 2027, in an invitation sent on 24 April to all WHO member states. WHO confirmed this in an email to Health Policy Watch. The invitations had been sent via private letters to countries’ Geneva missions. The period in which member states may nominate candidates will now run for six months, until 24 September. Contenders who have until now remained in the shadows are expected to begin coming forward publicly with their candidacies at the World Health Assembly in May. From the German perspective, Berlin wants its financial weight reflected in executive influence at the multilateral level as the largest global health donor following the US withdrawal from the WHO in January 2025. The withdrawal, combined with the US non-payment of dues owed, thrust WHO into a budget crisis, prompting layoffs of about 25% of the workforce in the past year. German Foreign Ministry neither confirms nor denies The German Foreign Ministry, formally responsible for the nomination, declined to confirm or comment on Braun’s potential candidacy when responding to a query by Health Policy Watch. Germany’s other potential candidates include the contested former Health Minister Karl Lauterbach and the lesser-known Paul Zubeil. In contrast, Braun’s dual profile as an accomplished politician, skilled financial manager, and trained physician and researcher who successfully built cross-party bridges offers a distinct advantage. But he is little known outside of Germany. Bridge-builder with executive and medical expertise Former Chair of the influential German Budget Committee, Helge Braun (right), and former French Chair of the Finance Committee, Claude Raynal (left), in the Bundestag. The current WHO leadership landscape demands a candidate capable of managing deep institutional fractures and uniting a divided global community. Despite him being largely unknown in the international community, Germany could be expected to emphasise Braun’s extensive fiscal and crisis management experience in any candidacy it mounts. As ‘Head of the Chancellery’, effectively Chief of Staff, in Angela Merkel’s last term as Chancellor, from 2018 to 2021, Braun operated at the nexus of scientific advice and political implementation during the COVID-19 pandemic, notably comparing the Chancellery to an intensive care unit where acute problems must be solved. Between 2021 and 2025, Braun then chaired the powerful Budget Committee of the German Bundestag (Parliament), overseeing the distribution and management of hundreds of billions of Euros with strict discipline This profound understanding of macroeconomic management, coupled with his pragmatic defence of Germany’s controversial debt ceiling alongside crisis-driven special funds, makes him an attractive prospect for donor nations currently demanding more financial accountability and restructuring at WHO in Geneva. Serving as a central mediator across government ministries, Braun built a reputation as a highly pragmatic problem solver whose past domestic political affiliations will not necessarily dictate his future approach to global health governance. This pragmatism complements his longstanding political advocacy for research into infectious diseases like Ebola and malaria. And unlike many career politicians, Braun’s foundational expertise lies in medicine, having worked for years as an intensive care physician and anaesthesiologist. He returned to these roots in April 2025 by assuming the presidency of the University of Lübeck, an institution renowned for its focus on life sciences and artificial intelligence. Why the candidacy might spark concerns WHO member states are currently negotiating a pathogen access and benefit-sharing (PABS) system in Geneva. While Braun championed early interventions and massive digitisation projects in his role as Merkel’s Head of the Chancellery during the COVID pandemic, severe bureaucratic delays hampered the rollout of vaccination campaigns and testing strategies. This tarnished his crisis management legacy just as he exited the federal government. His domestic political capital suffered further damage during the December 2021 Christian Democratic Union leadership election, where he lost heavily to conservative rival Friedrich Merz, now Chancellor. Party members largely rejected Braun as an establishment candidate, perceiving him as too closely aligned with the moderate legacy of former Chancellor Angela Merkel. Additionally, it is questionable whether Braun would wield the necessary diplomatic connections and familiarity with foreign health systems to be effective on Day One of a term as WHO head. The Director-General must immediately command trust and authority on the international stage, particularly when dealing with health ministries and stakeholders in the Global South. Most notably, the German government opposed the release of COVID-19 vaccine patents during his tenure, drawing sharp criticism from international health equity advocates. Defending this refusal in May 2021, Braun wrote in a guest article for the German newspaper Die Zeit that “patent protection as a driver of innovation is not the problem in this crisis, but an essential foundation for its solution.” In the Global South, this track record could thus reinforce the perception that Germany defends pharmaceutical interests over equitable technology transfer – especially in the face of current PABS Annex negotiations. Recent reports from Tagesspiegel Background indicating that the former minister was approached by Germany’s Association of Research-Based Pharmaceutical Companies to become their next president, when the post becomes vacant at the end of 2026, might further fuel these concerns. Finally, Germany has been cutting back its Official Development Assistance (ODA) in general, including contributions to the World Health Organization, where it has historically been the largest member state donor after the United States. On Wednesday, the Merz government announced its 2027 budget plans with further ODA cuts following last year’s drastic 17% reductions. The likelihood of Germany fulfilling its original 2024 financial pledge to WHO for the current biennium (2026-27) also remains in doubt. “They can put forward a candidate, but I don’t think it’s going to get a lot of traction from other member states,” said one informed WHO source. “At a time when Germany is reducing global health funding to member states, I don’t think they can go ahead and claim the top seat.” Step back and support allied candidates? Braun served as Head of Chancellery under then German Chancellor Angela Merkel, seen here with WHO Director General Dr Tedros in Berlin in 2021. Furthermore, domestic opinion remains highly divided on mounting a campaign amidst the geopolitical strains on Chancellor Friedrich Merz’s coalition and Tedros has reportedly urged Germany to back allied candidates instead. At the same time, the desire to seize more leadership in the UN system remains strong after Germany’s failed previous attempt to secure the top role at the UN High Commissioner for Refugees in 2025. Currently, Germany is also pushing for another attempt at a UN Security Council seat. Should Germany put forward a candidate, Foreign Minister Johann Wadephul, who will make the final decision, also faces a stark choice between Braun and the better-known Karl Lauterbach, as well as Paul Zubeil with his strong international health and technical background. Advancing a WHO outsider like Braun against established public health veterans is a highly calculated risk for Berlin, which must first convince other European countries to rally behind him. In case Berlin formally nominates Braun, the success of his candidacy will depend entirely on how effectively the government can reframe his perceived lack of field experience and global networks as delivery on fresh, badly needed fiscal expertise and perspectives. Grappling with WHO’s funding crisis As the race for the next Director-General opens for formal nominations, the names of over a dozen high-profile potential candidates are still circulating – from Indonesia to the United Kingdom. Want to Become the Next WHO Director-General? Get in Line And the list is still growing. Among the newer names being floated is that of Dr Hanan Mohamed al-Kuwari, who served as Qatar’s Minister of Public Health until November 2024 and chaired the 153rd Session of the WHO Executive Board. Before joining the Hamad Medical Corporation in 1996, where she ultimately rose to managing director, al-Kuwari worked for Reuters and as a freelance health reporter. Holding a PhD in healthcare management from Brunel University and bringing early career experience from the WHO, she represents a highly networked voice from the Arab world, celebrated for her crisis resilience and for shaping the WHO’s recent global work programme. Dr Maria Neira, former WHO Director of Climate, Environment and Health Another candidate who has been mentioned is Spain’s Dr Maria Neira, who recently retired from WHO as the director of Climate, Environment and Health. An iconic spokesperson for the climate, environment and health movement, Neira is known as a telegenic personality and adroit politically. As a young medical doctor, she worked in emergency relief in Latin America and Africa, and later served as Spain’s Vice Minister of Health and Consumer Affairs as well as President of the Spanish Food Safety and Nutrition Agency. However, Spain also recently decided to nominate a candidate to head the UN Food and Agriculture Organization (FAO), when Qu Dongyu’s second term as Director General ends in July 2027, leaving doubts about whether it would want to mount yet another campaign, in parallel. Continuing decline in ODA and global health aid Drastic ODA cuts and reduced global health funding leave vulnerable populations in precarious conditions worldwide. Whoever is elected will have to continue grappling with the continuing long-term declines in donor-driven ODA, and particularly global health aid – directly to countries and to WHO. While WHO 2026-2027 $4.2 billion base budget is now 85% financed, according to Tedros’ comments on Wednesday, declines in ODA continue to cast uncertainty on how the remaining $630 million gap will be filled. It’s unlikely that the $260.6 million in assessed US contributions still due for years 2024-2025, before the withdrawal became official in January, will ever be repaid, conceded WHO’s Tedros at a Geneva press briefing on Wednesday. “We’re hoping to get the money, but no signals yet,” Tedros told journalists, adding: “No signals means maybe we may not be able to get the money. The likelihood could be not getting the money.” “We’re looking at nontraditional donors. We’re looking at international financial institutions and other ways to mobilize that 15%,” Tedros said, in terms of filling that gap. “It’s not that we won’t go to the traditional donors, but I think we’re expanding that donor base.” This article has been edited to reflect additional information regarding Dr Hanan Mohamed al-Kuwari’s early career as a freelance journalist. Image Credits: X/Dr Tedros, Deutscher Bundestag/Leon Kügeler, European Commission. 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Landmark EU Vote Demands ‘Only Yes Means Yes’ Rape Law, Targeting Gaps in Survivor Care 01/05/2026 Felix Sassmannshausen Legislators Joanna Scheuring-Wielgus and Evin Incir present the parliament’s demand for a rape law based on an ‘only yes means yes’ principle. STRASBOURG – Amid a global backlash against sexual and reproductive rights, the European Parliament has taken a decisive stand by voting for a unified, human rights-based standard for sexual offences. This Europe-wide legislative push aims to overhaul the fragmented national laws that currently leave many survivors without access to justice or essential health support. The resolution formally urges the European Commission to draft binding laws that recognise rape is fundamentally defined by a lack of consent. This represents a stark departure from outdated national models that require victims to physically fight back or explicitly say no. Swedish lawmaker Evin Incir addresses the European Parliament. “It is both morally and legally unacceptable that women are not protected by ‘only yes means yes’ legislation across the EU,” leading lawmaker Evin Incir from the centre-left social democrats (S&D) declared following the plenary vote on Tuesday. Just hours earlier, the European Parliament had adopted a landmark report with 447 votes in favour, 160 votes against, and 43 abstentions, demanding a unified standard for sexual offences. The push for reform is driven by a societal reckoning, spurred by cases that have sparked international outrage, such as that of Gisèle Pelicot in France. During a high-profile 2024 trial, the public learned that Pelicot’s husband had covertly drugged and raped her over a decade, also inviting dozens of men to rape her while she was unconscious. Human rights baseline: only yes means yes Comparison between outdated force-based legal requirements and the Parliament’s proposed standard of affirmative, voluntary consent. At the core of the European debate is the push for an ‘only yes means yes’ principle to ensure that any sexual act without freely given consent is legally classified as a crime. While a clear verbal “yes” is the most direct method, legal experts emphasise that consent can be expressed in any voluntary and unambiguous way, meaning affirmative gestures or reciprocal actions, depending on the specific context of the relationship. Establishing legislation focused on the lack of consent is widely viewed as the necessary next step to implement the Istanbul Convention. Opened for signature in 2011 and ratified or acceded to by 39 parties, Article 36 of this comprehensive international treaty explicitly requires member states to criminalise all non-consensual sexual acts, setting a clear human rights baseline. A unified legal definition is essential for health policy, as it directly impacts how survivors access emergency contraception, trauma counselling, and forensic medical care. Recognising the health sector’s critical role in this recovery process, the WHO Regional Office for Europe provides health system baseline assessments to help stakeholders monitor member states’ compliance with the Istanbul Convention. The latest comprehensive EU gender-based violence survey reveals that a staggering 30.7% of women across the bloc have experienced physical or sexual violence, which aligns with global data. Crucially, 8.4% of women report being raped while under coercion or being unable to refuse, nearly double the 4.8% who experienced overt physical force. Despite this high prevalence, systemic barriers continue to suppress official reporting and hinder access to post-rape care. Only 13.9% of victims ever contact the police, frequently citing embarrassment, fear of retaliation, or a belief that law enforcement cannot help them as their primary reasons for silence. Acknowledging trauma and fear responses Neurobiological evidence from the Karolinska Institute shows 70% of survivors experience paralysis, supporting calls for an ‘only yes means yes’ approach. A critical aspect of focusing on the lack of consent involves officially recognising the physiological realities of trauma. Medical experts and victim advocates continuously stress that a lack of physical resistance does not equate to a voluntary agreement. Co-rapporteur Joanna Scheuring-Wielgus during the plenary debate. Legislators underscored the neurobiological “freeze” response, where a victim perceives overwhelming danger, and the body is rendered completely paralysed. “It’s important to understand that a victim may not always have the strength to fight, to say no,” Polish co-rapporteur Joanna Scheuring-Wielgus explained at the press conference. While some victims might actively fight back, others can also freeze or faint. A 2017 Swedish study from the Karolinska Institute found that 70% of sexual assault survivors experience significant “tonic immobility,” an involuntary, temporary state of motor inhibition triggered by intense fear. Current legal systems in several member states routinely dismiss cases where victims experienced this involuntary physiological paralysis, which the European Parliament notes causes severe secondary victimisation. Furthermore, victim support networks like Women Against Violence in Europe (WAVE) warn that failing to provide trauma-informed, gender-specific responses deters survivors from seeking essential medical and psychological support. Implementing laws based on an ‘only yes means yes’ principle would mandate that judges and law enforcement officials understand these complex trauma responses. Policy analysts argue this shift is vital for building trust in public institutions and ensuring that victims feel safe enough to access specialised healthcare services. Fractured legal landscape leaves survivors vulnerable German legal barriers create a stark gap between rising rape reports and actual criminal convictions. The contrast between different national models highlights why European lawmakers are demanding unified rules. In Germany, the current framework dictates that a victim must signal refusal, meaning perpetrators often escape conviction if the victim remains passive due to fear. According to recently published data from the Federal Criminal Police, 14,454 rapes were reported in Germany in 2025, an 8.5% increase that officials attribute primarily to a growing willingness among victims to come forward. However, the consequences of the current legal framework are still reflected in extremely low conviction rates, with the women’s rights organisation Terre des Femmes estimating that only one in one hundred rapes ultimately results in a conviction. Legal practitioners, including the German Women Lawyers Association, argue that this standard protects perpetrators rather than victims by shifting the responsibility of communication onto the assaulted person. They maintain that establishing the lack of consent as the legal threshold is the necessary next step to enable more victims to seek justice. Conversely, countries such as Sweden and Spain have recently reformed their penal codes to ensure that sexual relations must be affirmatively agreed upon. While Sweden has already recorded a subsequent rise in convictions due to broadened evidence admissibility, monitors note that Spain’s groundbreaking 2022 law has yet to translate into similar statistical increases. Political tide is changing in Europe After tough negotiations, the European Parliament voted for a unified legal standard based on an ‘only yes means yes’ principle on Tuesday. The road to a unified standard has been fraught with conflict. During the 2024 negotiations for the EU’s first Directive on violence against women, a blocking minority led by France, Germany, and Hungary successfully stripped rape from the final text. Rapporteur Evin Incir reminded the public of the “unholy alliance” of leaders – including Viktor Orbán and Emmanuel Macron – who formed this blocking minority. These national leaders had argued that the European Union lacked the legal competence to harmonise criminal laws on sexual violence. Only US Votes Against Women’s Rights Document at UN Commission However, the political winds are shifting. Mounting public pressure has forced national governments to reconsider, with countries like France now actively revising their own criminal codes to align with an ‘only yes means yes’-based model. Despite the momentum, the proposal faces fierce opposition from far-right factions who frame the initiative as an ideological overreach. During the Strasbourg debate, an MEP from the Patriots for Europe group argued that “human relationships do not unfold through formalized steps or legal checklists,” claiming the law would amount to morally policing intimate desire. Other right-wing voices attempted to pivot the debate toward anti-immigrant narratives, suggesting lawmakers should “protect the streets, not the bedrooms”. Progressive lawmakers swiftly rejected this framing, citing data that proves the vast majority of sexual assaults are committed by perpetrators known to the victim, underscoring the systemic, domestic nature of the crisis. More than judicial reform needed The proposed European standard combines legal reform with mandatory education and trauma-informed training for law enforcement. Establishing the ‘only yes means yes’ principle as the legal threshold for rape demands a fundamental re-evaluation of how European societies view sexual availability and interpersonal power dynamics. The core premise is that sexual partners must actively communicate their desires and mutually negotiate the boundaries of their intimacy. However, reforming the penal code to reflect the lack of consent is only one part of the broader societal transformation envisioned by the European Parliament. Lawmakers are heavily emphasising the need for mandatory, comprehensive sexuality and relationship education across all member states. To ensure these legal reforms are effectively applied, parliamentarians are also demanding mandatory, trauma-sensitive education for law enforcement officers to prevent secondary victimisation during police investigations. “Why in 2026 should it be controversial that we demand that it should be mandatory for those who are working to support these women and girls who are victims?” rapporteur Incir asked, pointing to the tough negotiations with conservative co-legislators. The European Commission has signalled its readiness to support this cultural shift by mapping the current legal landscape across the Union to identify further legislative action. However, it could take years before an EU-wide law takes effect: after the Commission proposes a legal framework, the parliament and EU member states have to negotiate their positions and find a compromise. Image Credits: Felix Sassmannshausen/HPW. Energy Transition ‘Past Point of No Return,’ 57 Nations Declare at First Fossil Fuel Phase-Out Summit 01/05/2026 Stefan Anderson Coalition launches first sustained diplomatic push to phase out oil, gas and coal as war in the Middle East exposes the costs of fossil fuel dependence. The first international conference on phasing out the oil, gas and coal igniting the climate crisis ended with 57 governments representing every continent and a third of the global economy declaring the transition away from fossil fuels is now irreversible. “Actions taken to date prove that the energy transition is past its point of no return,” the coalition declared in its closing document, affirming all members were “ready to advance their transition away from fossil fuels.” The momentum is partly driven by concern for the planet, but also by a strategic desire for the energy independence that renewables could provide in an era of geopolitical instability – a case sharpened by the havoc the war in the Middle East was wreaking on the global economy as delegates gathered on Colombia’s Caribbean coast. “In a time that has been marked by fragmentation, that has been affected by war, by mistrust and the climate crisis, to sit here together and talk about the challenges, talk about the taboos, it’s a deep transformation of policy,” Irene Vélez Torres, Colombia’s environment minister and conference co-chair, said in her closing remarks in Santa Marta. Conference co-chairs Irene Vélez Torres, Colombia’s environment minister, and Stientje van Veldhoven, the Dutch climate minister, celebrate at the closing plenary. “When they look back at us from the future, they will remember that we were there, working on the challenges of our time,” Vélez Torres added. “That we decided not to focus on an economy built on war and destruction — we decided instead that it was necessary to prioritise life, security, certainty, sovereignty and solidarity.” The conference produced no binding commitments, no finance pledges, no promises of emissions cuts — that wasn’t the point. Instead, organisers pitched the summit as a “safe space” for countries already committed to phasing out fossil fuels to speak frankly. No negotiations, no consensus text to be watered down, no red lines passed down from governments to throw a wrench into discussions. A space free of the fossil fuel lobbyists who fill the corridors of UN climate summits by the thousands, both openly and embedded in petrostate delegations, often outnumbering full national delegation teams. “The fact we didn’t have negotiations here makes for such a different dynamic,” said Stientje van Veldhoven, the Dutch climate minister and co-chair alongside Vélez Torres. “The psychology of the Santa Marta process is something that we will definitely make sure to carry forward.” A coalition born of frustration Two weeks of negotiations in Belém, Brazil, failed to address a phase-out plan for coal, oil and gas as more than 100 nations blocked language on the fossil fuels at the root of the climate crisis. Three years on from the COP28 breakthrough in Dubai, where nearly 200 countries agreed to “transition away from fossil fuels,” efforts to translate the pledge into concrete action have hit a wall. Negotiations to agree a phase-out roadmap at COP30 in Brazil last November were torpedoed by a coalition of petrostates led by Saudi Arabia, which drew over half of the nations in attendance to its side in opposing the plan. The final text in Belém contained no reference to “fossil fuels” at all, a marked step backwards for the UN climate process. Without that failure, the Santa Marta conference would not exist. Conceived in the hours after COP30 collapsed, the new process was born of frustration with the gridlock of consensus-based UN climate diplomacy. But its architects stressed that it is meant to be complementary to mainstream COPs, not to replace them. “It’s very important that we agree on the fact that we want this conference, this process, to be like an accelerator for what we want to do in the context of UNFCCC,” van Veldhoven said, adding that the chairs have already been in touch with the COP31 presidency. Alongside government ministers, the conference included nearly 3,000 representatives of subnational governments, trade unions, scientists, civil society groups, Indigenous Peoples, women’s organisations and youth representatives, all named in the closing document as equal participants rather than observers, the title they hold in UN negotiations. “A new reality is taking shape: this is no longer a one-off moment, but the foundation of an ongoing international process dedicated to phasing out fossil fuels,” said Kumi Naidoo, president of the Fossil Fuel Treaty Initiative. “What is emerging is a process that can finally match climate diplomacy to the scale of the crisis.” Countries will attempt to carry the momentum forward at the next phase-out conference, confirmed in the closing hours to be held in 2027 on the Pacific island of Tuvalu and co-hosted by Ireland, pairing a wealthy European island with one across the globe at risk of disappearing under sea-level rise. “We are making history. We have proven, in the words of our youth, that another way is possible,” Tuvalu’s representative said. “The world is in a fossil fuel crisis, of climate breakdown, of conflict, of instability. But here in Santa Marta, we have planted a seed of solutions.” The tailwind from Hormuz Roughly a fifth of the world’s oil passes through the Strait of Hormuz, where wartime disruptions have driven prices to their highest level in years and exposed how much the global economy still depends on fossil fuels. Running through the conference was the war between Israel, the United States and Iran, which has disrupted shipping through the Strait of Hormuz, tightening gas supplies across Europe and Asia and skyrocketing oil prices to their highest level in years. On the same day delegates closed proceedings, US President Donald Trump told reporters Iran would have to “cry uncle” before he lifted what he called his “genius” blockade. Brent crude hit $126 a barrel hours later, approaching the spike that followed Russia’s invasion of Ukraine in 2022. For the three-quarters of the world that depends on fossil fuel imports, the message of the past five days was hard to miss: their energy costs, inflation rates, fiscal stability and the prices their citizens pay for food and fuel are tied to decisions made by a handful of leaders in Washington, Moscow and Riyadh – none of whom were in Santa Marta. The coalition’s closing document named the Hormuz crisis directly, calling the disruptions a demonstration “that reducing fossil fuel dependencies is critical” to “keep our planet livable, to safeguard energy security, and to build economic resilience to volatile fossil fuel markets.” “Destructive oil wars, widening fuel and food shocks, and a mounting climate crisis only bolster the conviction that breaking free from the fossil fuel system is not a matter of magical realism but of radical realism, in line with science and the law,” said Nikki Reisch, director of climate and energy at the Centre for International Environmental Law. Van Veldhoven framed the crisis as part of the case for moving faster. “If these countries significantly reduce their dependency on fossil fuels, it means they’ll be investing in their own economy instead of importing fossil fuels from abroad,” she told Bloomberg. “It means they’ll be investing in clean technologies, but it also means they’ll be shielding their economies against the kind of price shocks we’re seeing currently.” Santa Marta: Key outcomes from first summit on ‘transitioning away’ from fossil fuels | @daisydunnesci Read here: https://t.co/YGUgQR5BTg pic.twitter.com/1nZuILSPO7 — Carbon Brief (@CarbonBrief) May 1, 2026 France became the first major economy to act on that argument at scale during the conference, releasing a national roadmap to eliminate fossil fuels from its energy mix by 2050. The plan does not introduce new pledges but consolidates existing French climate and energy targets under a single explicit goal: ending the use of oil, gas and coal for energy purposes by 2050. Globally, the picture is mixed. Fossil fuels remain responsible for more than 75% of greenhouse gas emissions, but new renewable capacity in 2025 is nearly 50% higher than in 2023, and renewables are meeting nearly all new energy demand, according to the International Energy Agency. Investment in the energy transition reached a record $2.4 trillion in 2024, more than double 2019 levels, though it is concentrated in advanced economies and China, IRENA found. “This momentum is not yet enough to deliver the needed breakthrough,” said Bronwen Tucker, public finance lead at Oil Change International. “The richest polluting countries must take immediate action to accelerate their transitions at home and show up with meaningful international economic cooperation.” Coalition of the self-aware For all its ambition, the coalition openly admitted the limits of its own reach. The outcome document released in Santa Marta lays out in candid detail the shortcomings of the coalition in Colombia, and the distance all nations still have to go to achieve the transition away from fossil fuels. Chief among these admissions is the degree to which most nations in attendance continue to be dependent on oil, gas or coal for the public revenues that fund health, infrastructure and other government functions, and ensure energy security. Until governments find a way to replace that funding, walking away from fossil fuel production remains off the table. “The countries present in Santa Marta still have structural dependencies to overcome, including fiscal dependencies, debt constraints, the dependence of the financial architecture on fossil fuels,” the outcome paper states. “Transitioning away from fossil fuels is more than replacing one energy source with another … the transition itself is complex.” Many others simply do not have the financial headroom to invest in renewables due to looming debt payments and empty balance sheets. “We must confront economic dependence on fossil fuels that shape the realities we face,” Tuvalu’s delegate said. “Unsustainable debt, reliance on fossil fuel revenues, and a global financial system that was not built for us, and too often fails us.” The coalition also recognised the limits of its own power. While the alliance contains a meaningful contingent of major fossil fuel producers – Norway, Canada, Australia, the United Kingdom, Brazil, Mexico, Nigeria, Angola and Colombia itself – what it does not contain is a critical mass of global fossil fuel supply or demand. The 57 countries present make up about a fifth of global fossil fuel production, a third of oil and gas demand, and the same share of world economic output. The five biggest fossil fuel producers – the United States, China, Russia, India and Saudi Arabia – were all absent. Together, they control nearly half the world economy, and pump about 45% of the world’s oil, half its natural gas and three-quarters of its coal, far outstripping the heft of the Santa Marta coalition on all fronts. “We are here with an immense group, and yet it is still too small a group for what our ambition actually is,” van Veldhoven said. “Let’s make sure that we continue to drive this process as an open coalition. That means we have to ensure visibility of the outcomes and use that as an invitation to others to join us.” Rockstars to the rescue Attendees gather for the launch of the Science Panel for the Global Energy Transition (SPGET) in Santa Marta. A concrete outcome of the summit is the creation of a new scientific panel to advise nations on the practice and policy of the fossil fuel phase-out, an idea born in the halls of COP30, which Vélez Torres pitched as a sort of climate scientists’ Avengers team of “rock star academics”. “This panel not only repairs a historical debt of an organisation dedicated, finally and for the first time, to overcoming fossil fuels in the energy matrix,” she said, “it will also tell us about other types of challenges regarding the social and economic limitations of being able to carry out this transition as quickly as possible.” The Science Panel for the Global Energy Transition (SPGET) will unite over 100 scientists and academics to guide nations in policymaking and emissions pathway analysis with the goal of keeping the 1.5°C warming target enshrined in the Paris Agreement alive. The independent panel will focus on mapping policy options, green technologies and financial mechanisms that can be harnessed by countries to reduce emissions and fossil fuel dependence. Johan Rockström, director of the Potsdam Institute for Climate Impact Research and co-lead of SPGET, said it will operate as a “scientific service” to governments, helping them figure out the balance of energy supply and demand with a “scientifically aligned, just and orderly phase out of fossil fuels.” “[The panel] will also enable us to have feedback into the COP process so that we can keep the fossil fuel phase-out discussions in plenary at the COP meeting alive,” Rockström said. “Now is the moment to tip the scales, to not allow anymore that a few actors at the COP meetings always block the most important discussion of them all: the phase-out of coal, oil and gas.” The hard the work begins Delegates arrive for high-level ministerial sessions in Santa Marta, Colombia. The final agreement struck at Santa Marta establishes three “workstreams”: working groups of countries, experts and civil society that will meet between now and the next conference to develop policy options on the thorniest questions of the phase-out. The first will focus on national emissions roadmaps, taking specific aim at what Vélez Torres called the “punto ciego,” or blind spot, in the Paris Agreement: exported emissions. Under the Nationally Determined Contributions (NDCs) mandated in the Paris Accords, countries report emissions on a territorial basis, but not the emissions from fossil fuels they extract and sell to other countries. For major exporters, the effect on emissions calculations is enormous. Norway’s exported emissions from oil and gas are roughly ten times its territorial emissions. Saudi Arabia’s full emissions footprint rises to two and a half times its reported emissions, closing in on 5% of global CO2 on its own. “We are not making clear commitments about how we are going to control the emissions that are exported from producing countries,” said Vélez Torres, whose country, Colombia, sees its emissions more than double when its coal and oil exports are counted. “We want to be very clear, very honest about how to transition away from production as well.” Winding down production is one of the most complex questions in the phase-out debate. If demand falls first, producer countries face collapsing revenues and an economic crisis. If supply falls first, importers face energy shortages. A complementary workstream announced in Santa Marta, backed by the OECD, will look at how exporters and importers can coordinate their wind-downs so the two declines move in step, avoiding a scenario where one side pulls back faster than the other, leaving producers without buyers or importers without fuel before clean alternatives can fill the gap. Money traps, and future hopes Indigenous Peoples’ representatives played a central role in the Santa Marta phase-out talks. The final workstream, supported by the International Institute for Sustainable Development, takes on what the co-hosts called the three “traps” holding states back from moving faster on fossil fuel phase-outs: finance, debt and subsidies. It is, in many ways, the hardest of the three. Without alternative revenues lined up, governments cannot turn off the tap on production that pays their bills. The constraint tightens further as interest payments squeeze public budgets and credit ratings for developing nations render borrowing exceedingly expensive, leaving fossil fuel revenue indispensable and crowding out renewables investment. Then there are the subsidies. Governments worldwide handed roughly $1.3 trillion in direct support to fossil fuel producers and consumers in 2022 to keep pump and power prices low, according to the IMF, and as much as $7 trillion once the unpriced costs of pollution and climate damage are factored in. The direct figure alone is more than half the $2.4 trillion the world invested in the entire energy transition the same year, tilting the market against cheaper renewables as subsidies keep expensive fossil fuels price-competitive. In Ghana, the financial realities of fossil fuel dependence remain too steep to overcome, its delegate told the conference, despite the country supporting the phase-out goal. “In Ghana, fossil fuels remain deeply tied to government revenues that fund essential public services and to our broader energy systems,” he said. “We need a fossil fuel treaty that creates the necessary architecture for a just transition.” Ten-year-old Paula Pedro from Colombia speaks at the closing of the Santa Marta conference. That the coalition is willing to talk openly about the financial dependency at the heart of the phase-out is, for many participants, the most encouraging signal to come out of Santa Marta. Whether it can build bridges and expand its membership as the climate crisis accelerates is the question that will loom over COP31 in Antalya later this year, and in the run-up to Tuvalu in 2027. With the workstreams set and the next conference scheduled, it fell to a 10-year-old from Colombia to remind the room what the diplomacy was for. “Of the 12 million children we have in Colombia, eight out of ten of us are affected by fossil fuels and weather changes,” Paula Pedro, representing the Colombian children and youth coalition, told the assembly. “What we need, for the children, is that the people in this room do the math, but not only on paper, but accomplish change as a matter of fact.” “We’re not only the future,” Pedro said. “We are the present and beyond.” Image Credits: Colombian Environment Ministry, Colombian Environment Ministry, COP30, ColomColombian Environment Ministrybian Ministry o, Colombian Environment Ministry, Colombian Environment Ministry, Colombian Environment Ministry. Heartbroken Families Face Huge Structural Barriers When Trying to Prove Medical Negligence in India 01/05/2026 Arsalan Bukhari & Naila Tabassum Indian families face a huge struggle to get timely access to medical records of loved ones who have died in Indian health facilities, while the police can only lay a charge against a doctor if an independent medical expert first confirms negligence. NEW DELHI – India faces thousands of medical negligence cases every year, but structural problems make it extremely difficult for patients’ families to find out what has happened to their loved ones – let alone win compensation when treatment has been botched. “A shadow of death is looming over us,” Ashwini Bajaj, a Haryana-based businessman, told Health Policy Watch, recalling the treatment of his 24-year-old son, Deshbandhu, more than a year after his death. In December 2024, Deshbandhu, an MBA student at Punjab University and Bajaj’s only son, developed a fever that lasted more than two days. On 26 December, he visited a hospital near his university in Chandigarh, where he was prescribed medicines and given a series of tests, including a liver function test (LFT). By the time the results came out later that evening, Deshbandhu had returned to his parents’ home in Hisar, around 200 kilometres away. The next day, he went to a private hospital there, but his condition deteriorated rapidly. His oxygen saturation dropped to 65%, and doctors warned of acute liver failure. “We were told his condition was very critical and that the hospital did not have the resources to treat him,” Bajaj said. “We were asked to take him to a super-speciality hospital. It felt as if the ground beneath our feet had slipped away.” Deshbandhu was shifted to a major private hospital in Gurugram. “My son was there for over three weeks. His condition kept deteriorating. He went with jaundice, and he developed intestinal obstruction, kidney stress, and pneumonia,” Bajaj said. A few days after his 24th birthday, which was on 20 January 2025, Deshbandhu died. Bajaj says he has been unable to return to work. His case reflects broader systemic gaps in India’s healthcare system, where delays in critical care, weak referral systems, and limited transparency can have life-threatening consequences — and the lack of updated national data continues to hamper accountability. Transparency in treatment Deshbandhu Bajaj (24), a mountaineer and an MBA student who died in January 2025. His father, Ashwini Bajaj, alleges medical negligence. “Initially, I thought the doctors tried hard to save my child, but when I obtained all the medical reports, which took three to four months to obtain, I realised much time was lost before the actual treatment started,” Bajaj said. “When I made a day-by-day chart, I realised that, for at least four days, my son didn’t get the treatment he should have. “Every evening, I used to get payment requests promptly on my WhatsApp. If they could send payment requests, why can’t they share procedural updates the same way?” Rujhan Dhawan, a lawyer at the Punjab and Haryana High Court, told Health Policy Watch such opacity is a major barrier to accountability. “A patient, once admitted, is entirely dependent on the institution not only for treatment but also for truthful disclosure,” he said. “Critical information about procedures and complications is often not readily accessible to families.” Bajaj’s family spent over ₹30 lakh ($33,000) on treatment. He says he is not seeking compensation, but a legal framework that mandates transparency. Not an isolated case Deshbandhu’s case is not an isolated one. According to the 18th Annual MedLegal Review, 65,000 medical negligence cases were filed in India in 2025 alone. Radha Sharma (49), a resident of Rajasthan’s capital city Jaipur, died days after being given a TB drugs although she had been diagnosed with a liver-related illness. In Jaipar, around 270 kilometres from Gurugram, 55-year-old tax consultant Kishan Kumar Sharma is fighting a case linked to the death of his wife, Radha. On 3 March 2025, she developed mild jaundice and was admitted to a private hospital. A test suggested Budd-Chiari syndrome, a rare liver disorder. However, despite a negative tuberculosis test, Radha was prescribed the TB drug, Isoniazid, said Sharma. Isoniazid should not be prescribed to patients with liver disease who have bilirubin levels over 4 mg/dL, according to World Health Organization (WHO) guidelines. But Sharma says his wife’s liver disorder was overlooked. Radha’s condition deteriorated rapidly, and she died on 18 March. “I have a simple question,” Sharma said. “Why was my wife given Isoniazid? Was it part of any established protocol or something else?” The risks highlighted by such cases reflect a broader global problem. According to the WHO, an estimated 138 million patients are harmed every year due to unsafe medical care. Lack of dedicated investigative body Nishant Bharihoke, an advocate at the Delhi High Court who specialises in medical negligence cases, told Health Policy Watch the core issue lies in the absence of a dedicated independent investigative framework. “India does not have a dedicated body specifically tasked with investigating deaths or serious injuries caused by medical negligence,” he said. “When a patient dies, and the family suspects wrongdoing, there is no authority whose sole function is to find out what happened.” Complaints are typically routed through State Medical Councils, which may form inquiry committees. Their decisions can be appealed to the National Medical Commission, but Bharihoke argues that the system is structurally limited. “The National Medical Commission’s primary mandate is to regulate medical education. Its disciplinary board has no independent investigators and no power to enter hospitals and examine evidence,” he said. He also pointed to a legal loophole: since these proceedings are not strictly judicial, false statements made before such bodies do not result in perjury charges. For families like Bajaj’s and Sharma’s, he said, this gap deepens the sense of injustice. When cases turn criminal Simran Chhabra (21), a resident of Gurugram and MA student at Amity University, was suffering from a simple cough and cold. She died within minutes of being administered an intravenous injection. The family is fighting a medical negligence case in a Gurugram court. The gap becomes even wider when negligence overlaps with criminal allegations. One such case is the death of 21-year-old Simran Chhabra. On 21 January 2023, she visited a private hospital in Gurugram with symptoms of cough and cold. According to a prescription her brother, Sourabh Chhabra, shared with Health Policy Watch, she was administered an intravenous injection of Dynapar. This is usually used to treat pain and inflammation associated with arthritis or after surgery. “As soon as the injection was fully administered, Simran collapsed on the bed and froth began coming out of her mouth,” Sourabh said. “Everything happened within minutes. I had no time to understand what was going on.” She was referred to another hospital, where she was declared dead. According to Bharihoke, the family’s legal representative, the doctor later claimed that multiple emergency interventions were carried out, including five additional injections and cardiopulmonary resuscitation (CPR), using drugs typically administered in cases of severe allergic reactions. However, the post-mortem report reviewed by Health Policy Watch raises questions. It records only two puncture marks on her body, and there is no mention of a cannula (an intravenous tube) being used. If multiple injections were administered, the family asks why there is no corresponding physical evidence. In this case, they argue, the medical account and post-mortem findings do not align. “Forget conviction or arrest, even registering an FIR in such cases often requires court intervention,” Bharihoke said. A FIR is a First Information Report (FIR) in Indian medical negligence cases, a formal document prepared by police under Section 154 of the Criminal Procedure Code upon receiving information about alleged criminal negligence. Absence of a legal framework Several structural barriers insulate medical health practitioners against negligence cases, according to legal experts. “In India, police usually cannot even register a case against a doctor unless an independent medical expert first confirms negligence,” Bharihoke told Health Policy Watch. “In most cases, doctors are reluctant to give such opinions, especially against their peers.” The challenge is compounded by access to evidence. Hospitals retain control over key records, case files, prescriptions, nursing notes, and CCTV footage while families often receive only partial or delayed documentation. India also lacks a statutory system guaranteeing timely access to medical records for patients and their families. There is no clear legal mandate requiring investigators to immediately secure hospital evidence. Tanvi Dubey, a Supreme Court lawyer, told Health Policy Watch the legal framework itself raises the bar for accountability. “Criminal liability in medical negligence cases is limited to gross negligence, not simple errors of judgment,” Dubey said. “This significantly narrows the scope for prosecution.” Even initiating an investigation can be delayed: “Authorities are allowed to conduct preliminary inquiries before registering a case, which often means waiting for medical opinions and slows the process.” Dubey also pointed to the continued reliance on what is known in Indian law as the “Bolam principle,” where a doctor’s actions are judged against a body of medical opinion. “This makes expert testimony central. Unless a complainant can produce strong contrary evidence, it becomes very difficult to establish negligence,” she said. While multiple legal remedies exist, including consumer courts, civil litigation, and disciplinary proceedings, Dubey noted that each comes with limitations. “Criminal prosecution is rare, civil cases are slow and evidence-heavy, and disciplinary proceedings do not always ensure compensation or thorough fact-finding,” she said. Compared with Western peers, India faces two major policy gaps in patients’ treatment: the absence of a national electronic medical record (EMR) system, and the lack of a digital system connecting labs directly to the consulting doctor. Currently, India doesn’t have a mandatory EMR policy applicable to healthcare organisations. Even today, prescriptions, clinical notes, and drug administration records are still handwritten in the majority of hospitals and almost all smaller clinics. This makes them more vulnerable to tampering, loss and destruction. The absence of a nationwide electronic medical record system adds another layer of opacity. In many facilities, records remain handwritten and vulnerable to alteration; a gap Bharihoke alleges was evident in Simran’s case. Urgent reform is necessary India’s Minister of Health Jagat Prakash Nadda. Legal experts are calling on authorities to establish an independent statutory body to investigate medical negligence. Only families with the financial means and emotional capacity to pursue long legal battles are able to take up medical negligence cases. For many others, the burden becomes too heavy to carry. While the rules may appear neutral on paper, experts say their impact is deeply unequal. Legal and policy experts argue that the most urgent reform is structural, particularly the creation of an independent statutory body tasked solely with investigating patient safety incidents, particularly in cases involving death, permanent disability, or serious injury. Such a body should have the authority to enter hospital premises, access medical records, secure CCTV footage, and record statements. Its findings should be made public, while the evidence it collects remains protected from use in criminal or disciplinary proceedings. In England, the Health Services Safety Investigations Body (HSSIB), established in 2023, follows this approach by conducting independent investigations into patient safety incidents. Globally, different systems offer alternative approaches to accountability. In the United States, oversight is spread across multiple layers: state medical boards regulate conduct, a national database tracks malpractice records, hospitals report serious incidents, and patients can pursue civil litigation. China follows a three-tier system, allowing patients to first negotiate with hospitals, then seek mediation, and finally pursue civil lawsuits. In parts of Europe, including France and the Nordic countries, no-fault compensation systems allow patients to receive compensation without proving negligence, making the process more accessible and less adversarial. Aviation and rail safety investigations have long operated on similar principles, focusing on systemic failures rather than individual blame. For India, experts say the lesson is clear. Accountability frameworks do not have to rely solely on litigation. A system built on independent investigation, timely access to evidence, and patient-centric redress could help provide answers to families like the Bajajs and Sharmas. Image Credits: César Badilla Miranda/ Unsplash, Felix Sassmannshausen. No Pandemic Agreement Annex by World Health Assembly, Says Civil Society 30/04/2026 Kerry Cullinan (Left to right from top) Third World Network’s moderator and speakers Lauren Paremoer, KP Gopakumar and Tamara Prisenburg form AIDS Healthcare Foundation. The final missing piece of the Pandemic Agreement – a pathogen access and benefit-sharing (PABS) system – is unlikely to be agreed on by the World Health Assembly (WHA) later this month. This was the view of civil society observers of the talks taking place at the World Health Organisation (WHO) headquarters in Geneva, who briefed the media on Thursday. The sixth round of talks is scheduled to end late on Friday night (1 May). Earlier in the week, WHO Director General Dr Tedros Adhanom Ghebreyesus told a Geneva media briefing that “key differences remain on key issues”. “I still see a common will to reach consensus, which means I continue to believe there is a way to reach consensus,” Tedros added. Although the notion of a “hybrid” PABS system is being discussed informally, its proponent, the European Union (EU), has not presented any formal text, Third World Network’s (TWN) KM Gopakumar told the media briefing, which was hosted by TWN and the AIDS Healthcare Foundation. While Brazil and Botswana have apparently indicated that they might support a hybrid or “blended” compromise, the Africa Group is opposed to it, according to the civil society representatives. WHO member states are negotiating how to share both information about dangerous pathogens and some of the “benefits” that manufacturers may develop from that information – namely, vaccines, therapeutics and diagnostics (VTDs). The “hybrid” or “blended” proposal is a mix of mandatory and voluntary measures for sharing pathogen information and any benefits that flow from this information. It de-links information-sharing and benefit-sharing. Gopakumar said that, in terms of the blended agreements, countries that shared pathogens “will have the freedom to choose to attach certain conditions for sharing the data and the sample, including benefit sharing requirements” or share without any conditions. Kill the efficiency Shifting the choice to individual countries would undermine the efficiency of a single PABS system as users would need to negotiate with the individual countries instead of through a centralised system, he argued. “If you have a hybrid system, first of all, it kills the efficiency [of a single system], and second, it’s going to debase the access and benefit sharing norms set by the international instruments like the Convention on Biological Diversity and the Nagoya Protocol. Any attempt to dilute benefit-sharing obligations would be a “disaster” for equity, said AHF’s Tamara Prisenberg. Lauren Paremoer of the People’s Health Movement said that the blended model introduces “a two-track system for accessing pathogens” that violates access and benefit-sharing on an “equal footing” specified in Article 12 of the Pandemic Agreement. One track would allow anonymous users to access pathogen data without upfront commitments to benefit-sharing or legally binding contracts. The other was in line with Article 12, permitting access to pathogens through databases and laboratories that would require users to register and commit to specified benefit-sharing. Earlier in the day, the Intergovernmental Working Group (IGWG) briefed civil society on text-based negotiations, but very little of the text they shared had been “greened” to show agreement. EXCLUSIVE: WHO Opens Nominations for Next Director General; Germany May Advance Former Merkel Aide, Helge Braun 30/04/2026 Felix Sassmannshausen, Elaine Ruth Fletcher & Editorial team WHO DG Dr Tedros Adhanom Ghebreyesus issued a call for nominations for the DG elections. He recently travelled to Berlin, where he met with high-level politicians and the WHO’s Pandemic Intelligence team. As the World Health Organization (WHO) formally opens the nomination process for the next Director-General, Germany now appears likely to propose Helge Braun, Chief of Staff in former Chancellor Angela Merkel’s government, according to Berlin insiders. But after slashing its global health budget, sources question whether a German candidate can win wide support from other WHO member states. WHO Director-General Dr Tedros Adhanom Ghebreyesus has formally issued a call to WHO member states for nominations to the DG elections, scheduled for May 2027, in an invitation sent on 24 April to all WHO member states. WHO confirmed this in an email to Health Policy Watch. The invitations had been sent via private letters to countries’ Geneva missions. The period in which member states may nominate candidates will now run for six months, until 24 September. Contenders who have until now remained in the shadows are expected to begin coming forward publicly with their candidacies at the World Health Assembly in May. From the German perspective, Berlin wants its financial weight reflected in executive influence at the multilateral level as the largest global health donor following the US withdrawal from the WHO in January 2025. The withdrawal, combined with the US non-payment of dues owed, thrust WHO into a budget crisis, prompting layoffs of about 25% of the workforce in the past year. German Foreign Ministry neither confirms nor denies The German Foreign Ministry, formally responsible for the nomination, declined to confirm or comment on Braun’s potential candidacy when responding to a query by Health Policy Watch. Germany’s other potential candidates include the contested former Health Minister Karl Lauterbach and the lesser-known Paul Zubeil. In contrast, Braun’s dual profile as an accomplished politician, skilled financial manager, and trained physician and researcher who successfully built cross-party bridges offers a distinct advantage. But he is little known outside of Germany. Bridge-builder with executive and medical expertise Former Chair of the influential German Budget Committee, Helge Braun (right), and former French Chair of the Finance Committee, Claude Raynal (left), in the Bundestag. The current WHO leadership landscape demands a candidate capable of managing deep institutional fractures and uniting a divided global community. Despite him being largely unknown in the international community, Germany could be expected to emphasise Braun’s extensive fiscal and crisis management experience in any candidacy it mounts. As ‘Head of the Chancellery’, effectively Chief of Staff, in Angela Merkel’s last term as Chancellor, from 2018 to 2021, Braun operated at the nexus of scientific advice and political implementation during the COVID-19 pandemic, notably comparing the Chancellery to an intensive care unit where acute problems must be solved. Between 2021 and 2025, Braun then chaired the powerful Budget Committee of the German Bundestag (Parliament), overseeing the distribution and management of hundreds of billions of Euros with strict discipline This profound understanding of macroeconomic management, coupled with his pragmatic defence of Germany’s controversial debt ceiling alongside crisis-driven special funds, makes him an attractive prospect for donor nations currently demanding more financial accountability and restructuring at WHO in Geneva. Serving as a central mediator across government ministries, Braun built a reputation as a highly pragmatic problem solver whose past domestic political affiliations will not necessarily dictate his future approach to global health governance. This pragmatism complements his longstanding political advocacy for research into infectious diseases like Ebola and malaria. And unlike many career politicians, Braun’s foundational expertise lies in medicine, having worked for years as an intensive care physician and anaesthesiologist. He returned to these roots in April 2025 by assuming the presidency of the University of Lübeck, an institution renowned for its focus on life sciences and artificial intelligence. Why the candidacy might spark concerns WHO member states are currently negotiating a pathogen access and benefit-sharing (PABS) system in Geneva. While Braun championed early interventions and massive digitisation projects in his role as Merkel’s Head of the Chancellery during the COVID pandemic, severe bureaucratic delays hampered the rollout of vaccination campaigns and testing strategies. This tarnished his crisis management legacy just as he exited the federal government. His domestic political capital suffered further damage during the December 2021 Christian Democratic Union leadership election, where he lost heavily to conservative rival Friedrich Merz, now Chancellor. Party members largely rejected Braun as an establishment candidate, perceiving him as too closely aligned with the moderate legacy of former Chancellor Angela Merkel. Additionally, it is questionable whether Braun would wield the necessary diplomatic connections and familiarity with foreign health systems to be effective on Day One of a term as WHO head. The Director-General must immediately command trust and authority on the international stage, particularly when dealing with health ministries and stakeholders in the Global South. Most notably, the German government opposed the release of COVID-19 vaccine patents during his tenure, drawing sharp criticism from international health equity advocates. Defending this refusal in May 2021, Braun wrote in a guest article for the German newspaper Die Zeit that “patent protection as a driver of innovation is not the problem in this crisis, but an essential foundation for its solution.” In the Global South, this track record could thus reinforce the perception that Germany defends pharmaceutical interests over equitable technology transfer – especially in the face of current PABS Annex negotiations. Recent reports from Tagesspiegel Background indicating that the former minister was approached by Germany’s Association of Research-Based Pharmaceutical Companies to become their next president, when the post becomes vacant at the end of 2026, might further fuel these concerns. Finally, Germany has been cutting back its Official Development Assistance (ODA) in general, including contributions to the World Health Organization, where it has historically been the largest member state donor after the United States. On Wednesday, the Merz government announced its 2027 budget plans with further ODA cuts following last year’s drastic 17% reductions. The likelihood of Germany fulfilling its original 2024 financial pledge to WHO for the current biennium (2026-27) also remains in doubt. “They can put forward a candidate, but I don’t think it’s going to get a lot of traction from other member states,” said one informed WHO source. “At a time when Germany is reducing global health funding to member states, I don’t think they can go ahead and claim the top seat.” Step back and support allied candidates? Braun served as Head of Chancellery under then German Chancellor Angela Merkel, seen here with WHO Director General Dr Tedros in Berlin in 2021. Furthermore, domestic opinion remains highly divided on mounting a campaign amidst the geopolitical strains on Chancellor Friedrich Merz’s coalition and Tedros has reportedly urged Germany to back allied candidates instead. At the same time, the desire to seize more leadership in the UN system remains strong after Germany’s failed previous attempt to secure the top role at the UN High Commissioner for Refugees in 2025. Currently, Germany is also pushing for another attempt at a UN Security Council seat. Should Germany put forward a candidate, Foreign Minister Johann Wadephul, who will make the final decision, also faces a stark choice between Braun and the better-known Karl Lauterbach, as well as Paul Zubeil with his strong international health and technical background. Advancing a WHO outsider like Braun against established public health veterans is a highly calculated risk for Berlin, which must first convince other European countries to rally behind him. In case Berlin formally nominates Braun, the success of his candidacy will depend entirely on how effectively the government can reframe his perceived lack of field experience and global networks as delivery on fresh, badly needed fiscal expertise and perspectives. Grappling with WHO’s funding crisis As the race for the next Director-General opens for formal nominations, the names of over a dozen high-profile potential candidates are still circulating – from Indonesia to the United Kingdom. Want to Become the Next WHO Director-General? Get in Line And the list is still growing. Among the newer names being floated is that of Dr Hanan Mohamed al-Kuwari, who served as Qatar’s Minister of Public Health until November 2024 and chaired the 153rd Session of the WHO Executive Board. Before joining the Hamad Medical Corporation in 1996, where she ultimately rose to managing director, al-Kuwari worked for Reuters and as a freelance health reporter. Holding a PhD in healthcare management from Brunel University and bringing early career experience from the WHO, she represents a highly networked voice from the Arab world, celebrated for her crisis resilience and for shaping the WHO’s recent global work programme. Dr Maria Neira, former WHO Director of Climate, Environment and Health Another candidate who has been mentioned is Spain’s Dr Maria Neira, who recently retired from WHO as the director of Climate, Environment and Health. An iconic spokesperson for the climate, environment and health movement, Neira is known as a telegenic personality and adroit politically. As a young medical doctor, she worked in emergency relief in Latin America and Africa, and later served as Spain’s Vice Minister of Health and Consumer Affairs as well as President of the Spanish Food Safety and Nutrition Agency. However, Spain also recently decided to nominate a candidate to head the UN Food and Agriculture Organization (FAO), when Qu Dongyu’s second term as Director General ends in July 2027, leaving doubts about whether it would want to mount yet another campaign, in parallel. Continuing decline in ODA and global health aid Drastic ODA cuts and reduced global health funding leave vulnerable populations in precarious conditions worldwide. Whoever is elected will have to continue grappling with the continuing long-term declines in donor-driven ODA, and particularly global health aid – directly to countries and to WHO. While WHO 2026-2027 $4.2 billion base budget is now 85% financed, according to Tedros’ comments on Wednesday, declines in ODA continue to cast uncertainty on how the remaining $630 million gap will be filled. It’s unlikely that the $260.6 million in assessed US contributions still due for years 2024-2025, before the withdrawal became official in January, will ever be repaid, conceded WHO’s Tedros at a Geneva press briefing on Wednesday. “We’re hoping to get the money, but no signals yet,” Tedros told journalists, adding: “No signals means maybe we may not be able to get the money. The likelihood could be not getting the money.” “We’re looking at nontraditional donors. We’re looking at international financial institutions and other ways to mobilize that 15%,” Tedros said, in terms of filling that gap. “It’s not that we won’t go to the traditional donors, but I think we’re expanding that donor base.” This article has been edited to reflect additional information regarding Dr Hanan Mohamed al-Kuwari’s early career as a freelance journalist. Image Credits: X/Dr Tedros, Deutscher Bundestag/Leon Kügeler, European Commission. 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Energy Transition ‘Past Point of No Return,’ 57 Nations Declare at First Fossil Fuel Phase-Out Summit 01/05/2026 Stefan Anderson Coalition launches first sustained diplomatic push to phase out oil, gas and coal as war in the Middle East exposes the costs of fossil fuel dependence. The first international conference on phasing out the oil, gas and coal igniting the climate crisis ended with 57 governments representing every continent and a third of the global economy declaring the transition away from fossil fuels is now irreversible. “Actions taken to date prove that the energy transition is past its point of no return,” the coalition declared in its closing document, affirming all members were “ready to advance their transition away from fossil fuels.” The momentum is partly driven by concern for the planet, but also by a strategic desire for the energy independence that renewables could provide in an era of geopolitical instability – a case sharpened by the havoc the war in the Middle East was wreaking on the global economy as delegates gathered on Colombia’s Caribbean coast. “In a time that has been marked by fragmentation, that has been affected by war, by mistrust and the climate crisis, to sit here together and talk about the challenges, talk about the taboos, it’s a deep transformation of policy,” Irene Vélez Torres, Colombia’s environment minister and conference co-chair, said in her closing remarks in Santa Marta. Conference co-chairs Irene Vélez Torres, Colombia’s environment minister, and Stientje van Veldhoven, the Dutch climate minister, celebrate at the closing plenary. “When they look back at us from the future, they will remember that we were there, working on the challenges of our time,” Vélez Torres added. “That we decided not to focus on an economy built on war and destruction — we decided instead that it was necessary to prioritise life, security, certainty, sovereignty and solidarity.” The conference produced no binding commitments, no finance pledges, no promises of emissions cuts — that wasn’t the point. Instead, organisers pitched the summit as a “safe space” for countries already committed to phasing out fossil fuels to speak frankly. No negotiations, no consensus text to be watered down, no red lines passed down from governments to throw a wrench into discussions. A space free of the fossil fuel lobbyists who fill the corridors of UN climate summits by the thousands, both openly and embedded in petrostate delegations, often outnumbering full national delegation teams. “The fact we didn’t have negotiations here makes for such a different dynamic,” said Stientje van Veldhoven, the Dutch climate minister and co-chair alongside Vélez Torres. “The psychology of the Santa Marta process is something that we will definitely make sure to carry forward.” A coalition born of frustration Two weeks of negotiations in Belém, Brazil, failed to address a phase-out plan for coal, oil and gas as more than 100 nations blocked language on the fossil fuels at the root of the climate crisis. Three years on from the COP28 breakthrough in Dubai, where nearly 200 countries agreed to “transition away from fossil fuels,” efforts to translate the pledge into concrete action have hit a wall. Negotiations to agree a phase-out roadmap at COP30 in Brazil last November were torpedoed by a coalition of petrostates led by Saudi Arabia, which drew over half of the nations in attendance to its side in opposing the plan. The final text in Belém contained no reference to “fossil fuels” at all, a marked step backwards for the UN climate process. Without that failure, the Santa Marta conference would not exist. Conceived in the hours after COP30 collapsed, the new process was born of frustration with the gridlock of consensus-based UN climate diplomacy. But its architects stressed that it is meant to be complementary to mainstream COPs, not to replace them. “It’s very important that we agree on the fact that we want this conference, this process, to be like an accelerator for what we want to do in the context of UNFCCC,” van Veldhoven said, adding that the chairs have already been in touch with the COP31 presidency. Alongside government ministers, the conference included nearly 3,000 representatives of subnational governments, trade unions, scientists, civil society groups, Indigenous Peoples, women’s organisations and youth representatives, all named in the closing document as equal participants rather than observers, the title they hold in UN negotiations. “A new reality is taking shape: this is no longer a one-off moment, but the foundation of an ongoing international process dedicated to phasing out fossil fuels,” said Kumi Naidoo, president of the Fossil Fuel Treaty Initiative. “What is emerging is a process that can finally match climate diplomacy to the scale of the crisis.” Countries will attempt to carry the momentum forward at the next phase-out conference, confirmed in the closing hours to be held in 2027 on the Pacific island of Tuvalu and co-hosted by Ireland, pairing a wealthy European island with one across the globe at risk of disappearing under sea-level rise. “We are making history. We have proven, in the words of our youth, that another way is possible,” Tuvalu’s representative said. “The world is in a fossil fuel crisis, of climate breakdown, of conflict, of instability. But here in Santa Marta, we have planted a seed of solutions.” The tailwind from Hormuz Roughly a fifth of the world’s oil passes through the Strait of Hormuz, where wartime disruptions have driven prices to their highest level in years and exposed how much the global economy still depends on fossil fuels. Running through the conference was the war between Israel, the United States and Iran, which has disrupted shipping through the Strait of Hormuz, tightening gas supplies across Europe and Asia and skyrocketing oil prices to their highest level in years. On the same day delegates closed proceedings, US President Donald Trump told reporters Iran would have to “cry uncle” before he lifted what he called his “genius” blockade. Brent crude hit $126 a barrel hours later, approaching the spike that followed Russia’s invasion of Ukraine in 2022. For the three-quarters of the world that depends on fossil fuel imports, the message of the past five days was hard to miss: their energy costs, inflation rates, fiscal stability and the prices their citizens pay for food and fuel are tied to decisions made by a handful of leaders in Washington, Moscow and Riyadh – none of whom were in Santa Marta. The coalition’s closing document named the Hormuz crisis directly, calling the disruptions a demonstration “that reducing fossil fuel dependencies is critical” to “keep our planet livable, to safeguard energy security, and to build economic resilience to volatile fossil fuel markets.” “Destructive oil wars, widening fuel and food shocks, and a mounting climate crisis only bolster the conviction that breaking free from the fossil fuel system is not a matter of magical realism but of radical realism, in line with science and the law,” said Nikki Reisch, director of climate and energy at the Centre for International Environmental Law. Van Veldhoven framed the crisis as part of the case for moving faster. “If these countries significantly reduce their dependency on fossil fuels, it means they’ll be investing in their own economy instead of importing fossil fuels from abroad,” she told Bloomberg. “It means they’ll be investing in clean technologies, but it also means they’ll be shielding their economies against the kind of price shocks we’re seeing currently.” Santa Marta: Key outcomes from first summit on ‘transitioning away’ from fossil fuels | @daisydunnesci Read here: https://t.co/YGUgQR5BTg pic.twitter.com/1nZuILSPO7 — Carbon Brief (@CarbonBrief) May 1, 2026 France became the first major economy to act on that argument at scale during the conference, releasing a national roadmap to eliminate fossil fuels from its energy mix by 2050. The plan does not introduce new pledges but consolidates existing French climate and energy targets under a single explicit goal: ending the use of oil, gas and coal for energy purposes by 2050. Globally, the picture is mixed. Fossil fuels remain responsible for more than 75% of greenhouse gas emissions, but new renewable capacity in 2025 is nearly 50% higher than in 2023, and renewables are meeting nearly all new energy demand, according to the International Energy Agency. Investment in the energy transition reached a record $2.4 trillion in 2024, more than double 2019 levels, though it is concentrated in advanced economies and China, IRENA found. “This momentum is not yet enough to deliver the needed breakthrough,” said Bronwen Tucker, public finance lead at Oil Change International. “The richest polluting countries must take immediate action to accelerate their transitions at home and show up with meaningful international economic cooperation.” Coalition of the self-aware For all its ambition, the coalition openly admitted the limits of its own reach. The outcome document released in Santa Marta lays out in candid detail the shortcomings of the coalition in Colombia, and the distance all nations still have to go to achieve the transition away from fossil fuels. Chief among these admissions is the degree to which most nations in attendance continue to be dependent on oil, gas or coal for the public revenues that fund health, infrastructure and other government functions, and ensure energy security. Until governments find a way to replace that funding, walking away from fossil fuel production remains off the table. “The countries present in Santa Marta still have structural dependencies to overcome, including fiscal dependencies, debt constraints, the dependence of the financial architecture on fossil fuels,” the outcome paper states. “Transitioning away from fossil fuels is more than replacing one energy source with another … the transition itself is complex.” Many others simply do not have the financial headroom to invest in renewables due to looming debt payments and empty balance sheets. “We must confront economic dependence on fossil fuels that shape the realities we face,” Tuvalu’s delegate said. “Unsustainable debt, reliance on fossil fuel revenues, and a global financial system that was not built for us, and too often fails us.” The coalition also recognised the limits of its own power. While the alliance contains a meaningful contingent of major fossil fuel producers – Norway, Canada, Australia, the United Kingdom, Brazil, Mexico, Nigeria, Angola and Colombia itself – what it does not contain is a critical mass of global fossil fuel supply or demand. The 57 countries present make up about a fifth of global fossil fuel production, a third of oil and gas demand, and the same share of world economic output. The five biggest fossil fuel producers – the United States, China, Russia, India and Saudi Arabia – were all absent. Together, they control nearly half the world economy, and pump about 45% of the world’s oil, half its natural gas and three-quarters of its coal, far outstripping the heft of the Santa Marta coalition on all fronts. “We are here with an immense group, and yet it is still too small a group for what our ambition actually is,” van Veldhoven said. “Let’s make sure that we continue to drive this process as an open coalition. That means we have to ensure visibility of the outcomes and use that as an invitation to others to join us.” Rockstars to the rescue Attendees gather for the launch of the Science Panel for the Global Energy Transition (SPGET) in Santa Marta. A concrete outcome of the summit is the creation of a new scientific panel to advise nations on the practice and policy of the fossil fuel phase-out, an idea born in the halls of COP30, which Vélez Torres pitched as a sort of climate scientists’ Avengers team of “rock star academics”. “This panel not only repairs a historical debt of an organisation dedicated, finally and for the first time, to overcoming fossil fuels in the energy matrix,” she said, “it will also tell us about other types of challenges regarding the social and economic limitations of being able to carry out this transition as quickly as possible.” The Science Panel for the Global Energy Transition (SPGET) will unite over 100 scientists and academics to guide nations in policymaking and emissions pathway analysis with the goal of keeping the 1.5°C warming target enshrined in the Paris Agreement alive. The independent panel will focus on mapping policy options, green technologies and financial mechanisms that can be harnessed by countries to reduce emissions and fossil fuel dependence. Johan Rockström, director of the Potsdam Institute for Climate Impact Research and co-lead of SPGET, said it will operate as a “scientific service” to governments, helping them figure out the balance of energy supply and demand with a “scientifically aligned, just and orderly phase out of fossil fuels.” “[The panel] will also enable us to have feedback into the COP process so that we can keep the fossil fuel phase-out discussions in plenary at the COP meeting alive,” Rockström said. “Now is the moment to tip the scales, to not allow anymore that a few actors at the COP meetings always block the most important discussion of them all: the phase-out of coal, oil and gas.” The hard the work begins Delegates arrive for high-level ministerial sessions in Santa Marta, Colombia. The final agreement struck at Santa Marta establishes three “workstreams”: working groups of countries, experts and civil society that will meet between now and the next conference to develop policy options on the thorniest questions of the phase-out. The first will focus on national emissions roadmaps, taking specific aim at what Vélez Torres called the “punto ciego,” or blind spot, in the Paris Agreement: exported emissions. Under the Nationally Determined Contributions (NDCs) mandated in the Paris Accords, countries report emissions on a territorial basis, but not the emissions from fossil fuels they extract and sell to other countries. For major exporters, the effect on emissions calculations is enormous. Norway’s exported emissions from oil and gas are roughly ten times its territorial emissions. Saudi Arabia’s full emissions footprint rises to two and a half times its reported emissions, closing in on 5% of global CO2 on its own. “We are not making clear commitments about how we are going to control the emissions that are exported from producing countries,” said Vélez Torres, whose country, Colombia, sees its emissions more than double when its coal and oil exports are counted. “We want to be very clear, very honest about how to transition away from production as well.” Winding down production is one of the most complex questions in the phase-out debate. If demand falls first, producer countries face collapsing revenues and an economic crisis. If supply falls first, importers face energy shortages. A complementary workstream announced in Santa Marta, backed by the OECD, will look at how exporters and importers can coordinate their wind-downs so the two declines move in step, avoiding a scenario where one side pulls back faster than the other, leaving producers without buyers or importers without fuel before clean alternatives can fill the gap. Money traps, and future hopes Indigenous Peoples’ representatives played a central role in the Santa Marta phase-out talks. The final workstream, supported by the International Institute for Sustainable Development, takes on what the co-hosts called the three “traps” holding states back from moving faster on fossil fuel phase-outs: finance, debt and subsidies. It is, in many ways, the hardest of the three. Without alternative revenues lined up, governments cannot turn off the tap on production that pays their bills. The constraint tightens further as interest payments squeeze public budgets and credit ratings for developing nations render borrowing exceedingly expensive, leaving fossil fuel revenue indispensable and crowding out renewables investment. Then there are the subsidies. Governments worldwide handed roughly $1.3 trillion in direct support to fossil fuel producers and consumers in 2022 to keep pump and power prices low, according to the IMF, and as much as $7 trillion once the unpriced costs of pollution and climate damage are factored in. The direct figure alone is more than half the $2.4 trillion the world invested in the entire energy transition the same year, tilting the market against cheaper renewables as subsidies keep expensive fossil fuels price-competitive. In Ghana, the financial realities of fossil fuel dependence remain too steep to overcome, its delegate told the conference, despite the country supporting the phase-out goal. “In Ghana, fossil fuels remain deeply tied to government revenues that fund essential public services and to our broader energy systems,” he said. “We need a fossil fuel treaty that creates the necessary architecture for a just transition.” Ten-year-old Paula Pedro from Colombia speaks at the closing of the Santa Marta conference. That the coalition is willing to talk openly about the financial dependency at the heart of the phase-out is, for many participants, the most encouraging signal to come out of Santa Marta. Whether it can build bridges and expand its membership as the climate crisis accelerates is the question that will loom over COP31 in Antalya later this year, and in the run-up to Tuvalu in 2027. With the workstreams set and the next conference scheduled, it fell to a 10-year-old from Colombia to remind the room what the diplomacy was for. “Of the 12 million children we have in Colombia, eight out of ten of us are affected by fossil fuels and weather changes,” Paula Pedro, representing the Colombian children and youth coalition, told the assembly. “What we need, for the children, is that the people in this room do the math, but not only on paper, but accomplish change as a matter of fact.” “We’re not only the future,” Pedro said. “We are the present and beyond.” Image Credits: Colombian Environment Ministry, Colombian Environment Ministry, COP30, ColomColombian Environment Ministrybian Ministry o, Colombian Environment Ministry, Colombian Environment Ministry, Colombian Environment Ministry. Heartbroken Families Face Huge Structural Barriers When Trying to Prove Medical Negligence in India 01/05/2026 Arsalan Bukhari & Naila Tabassum Indian families face a huge struggle to get timely access to medical records of loved ones who have died in Indian health facilities, while the police can only lay a charge against a doctor if an independent medical expert first confirms negligence. NEW DELHI – India faces thousands of medical negligence cases every year, but structural problems make it extremely difficult for patients’ families to find out what has happened to their loved ones – let alone win compensation when treatment has been botched. “A shadow of death is looming over us,” Ashwini Bajaj, a Haryana-based businessman, told Health Policy Watch, recalling the treatment of his 24-year-old son, Deshbandhu, more than a year after his death. In December 2024, Deshbandhu, an MBA student at Punjab University and Bajaj’s only son, developed a fever that lasted more than two days. On 26 December, he visited a hospital near his university in Chandigarh, where he was prescribed medicines and given a series of tests, including a liver function test (LFT). By the time the results came out later that evening, Deshbandhu had returned to his parents’ home in Hisar, around 200 kilometres away. The next day, he went to a private hospital there, but his condition deteriorated rapidly. His oxygen saturation dropped to 65%, and doctors warned of acute liver failure. “We were told his condition was very critical and that the hospital did not have the resources to treat him,” Bajaj said. “We were asked to take him to a super-speciality hospital. It felt as if the ground beneath our feet had slipped away.” Deshbandhu was shifted to a major private hospital in Gurugram. “My son was there for over three weeks. His condition kept deteriorating. He went with jaundice, and he developed intestinal obstruction, kidney stress, and pneumonia,” Bajaj said. A few days after his 24th birthday, which was on 20 January 2025, Deshbandhu died. Bajaj says he has been unable to return to work. His case reflects broader systemic gaps in India’s healthcare system, where delays in critical care, weak referral systems, and limited transparency can have life-threatening consequences — and the lack of updated national data continues to hamper accountability. Transparency in treatment Deshbandhu Bajaj (24), a mountaineer and an MBA student who died in January 2025. His father, Ashwini Bajaj, alleges medical negligence. “Initially, I thought the doctors tried hard to save my child, but when I obtained all the medical reports, which took three to four months to obtain, I realised much time was lost before the actual treatment started,” Bajaj said. “When I made a day-by-day chart, I realised that, for at least four days, my son didn’t get the treatment he should have. “Every evening, I used to get payment requests promptly on my WhatsApp. If they could send payment requests, why can’t they share procedural updates the same way?” Rujhan Dhawan, a lawyer at the Punjab and Haryana High Court, told Health Policy Watch such opacity is a major barrier to accountability. “A patient, once admitted, is entirely dependent on the institution not only for treatment but also for truthful disclosure,” he said. “Critical information about procedures and complications is often not readily accessible to families.” Bajaj’s family spent over ₹30 lakh ($33,000) on treatment. He says he is not seeking compensation, but a legal framework that mandates transparency. Not an isolated case Deshbandhu’s case is not an isolated one. According to the 18th Annual MedLegal Review, 65,000 medical negligence cases were filed in India in 2025 alone. Radha Sharma (49), a resident of Rajasthan’s capital city Jaipur, died days after being given a TB drugs although she had been diagnosed with a liver-related illness. In Jaipar, around 270 kilometres from Gurugram, 55-year-old tax consultant Kishan Kumar Sharma is fighting a case linked to the death of his wife, Radha. On 3 March 2025, she developed mild jaundice and was admitted to a private hospital. A test suggested Budd-Chiari syndrome, a rare liver disorder. However, despite a negative tuberculosis test, Radha was prescribed the TB drug, Isoniazid, said Sharma. Isoniazid should not be prescribed to patients with liver disease who have bilirubin levels over 4 mg/dL, according to World Health Organization (WHO) guidelines. But Sharma says his wife’s liver disorder was overlooked. Radha’s condition deteriorated rapidly, and she died on 18 March. “I have a simple question,” Sharma said. “Why was my wife given Isoniazid? Was it part of any established protocol or something else?” The risks highlighted by such cases reflect a broader global problem. According to the WHO, an estimated 138 million patients are harmed every year due to unsafe medical care. Lack of dedicated investigative body Nishant Bharihoke, an advocate at the Delhi High Court who specialises in medical negligence cases, told Health Policy Watch the core issue lies in the absence of a dedicated independent investigative framework. “India does not have a dedicated body specifically tasked with investigating deaths or serious injuries caused by medical negligence,” he said. “When a patient dies, and the family suspects wrongdoing, there is no authority whose sole function is to find out what happened.” Complaints are typically routed through State Medical Councils, which may form inquiry committees. Their decisions can be appealed to the National Medical Commission, but Bharihoke argues that the system is structurally limited. “The National Medical Commission’s primary mandate is to regulate medical education. Its disciplinary board has no independent investigators and no power to enter hospitals and examine evidence,” he said. He also pointed to a legal loophole: since these proceedings are not strictly judicial, false statements made before such bodies do not result in perjury charges. For families like Bajaj’s and Sharma’s, he said, this gap deepens the sense of injustice. When cases turn criminal Simran Chhabra (21), a resident of Gurugram and MA student at Amity University, was suffering from a simple cough and cold. She died within minutes of being administered an intravenous injection. The family is fighting a medical negligence case in a Gurugram court. The gap becomes even wider when negligence overlaps with criminal allegations. One such case is the death of 21-year-old Simran Chhabra. On 21 January 2023, she visited a private hospital in Gurugram with symptoms of cough and cold. According to a prescription her brother, Sourabh Chhabra, shared with Health Policy Watch, she was administered an intravenous injection of Dynapar. This is usually used to treat pain and inflammation associated with arthritis or after surgery. “As soon as the injection was fully administered, Simran collapsed on the bed and froth began coming out of her mouth,” Sourabh said. “Everything happened within minutes. I had no time to understand what was going on.” She was referred to another hospital, where she was declared dead. According to Bharihoke, the family’s legal representative, the doctor later claimed that multiple emergency interventions were carried out, including five additional injections and cardiopulmonary resuscitation (CPR), using drugs typically administered in cases of severe allergic reactions. However, the post-mortem report reviewed by Health Policy Watch raises questions. It records only two puncture marks on her body, and there is no mention of a cannula (an intravenous tube) being used. If multiple injections were administered, the family asks why there is no corresponding physical evidence. In this case, they argue, the medical account and post-mortem findings do not align. “Forget conviction or arrest, even registering an FIR in such cases often requires court intervention,” Bharihoke said. A FIR is a First Information Report (FIR) in Indian medical negligence cases, a formal document prepared by police under Section 154 of the Criminal Procedure Code upon receiving information about alleged criminal negligence. Absence of a legal framework Several structural barriers insulate medical health practitioners against negligence cases, according to legal experts. “In India, police usually cannot even register a case against a doctor unless an independent medical expert first confirms negligence,” Bharihoke told Health Policy Watch. “In most cases, doctors are reluctant to give such opinions, especially against their peers.” The challenge is compounded by access to evidence. Hospitals retain control over key records, case files, prescriptions, nursing notes, and CCTV footage while families often receive only partial or delayed documentation. India also lacks a statutory system guaranteeing timely access to medical records for patients and their families. There is no clear legal mandate requiring investigators to immediately secure hospital evidence. Tanvi Dubey, a Supreme Court lawyer, told Health Policy Watch the legal framework itself raises the bar for accountability. “Criminal liability in medical negligence cases is limited to gross negligence, not simple errors of judgment,” Dubey said. “This significantly narrows the scope for prosecution.” Even initiating an investigation can be delayed: “Authorities are allowed to conduct preliminary inquiries before registering a case, which often means waiting for medical opinions and slows the process.” Dubey also pointed to the continued reliance on what is known in Indian law as the “Bolam principle,” where a doctor’s actions are judged against a body of medical opinion. “This makes expert testimony central. Unless a complainant can produce strong contrary evidence, it becomes very difficult to establish negligence,” she said. While multiple legal remedies exist, including consumer courts, civil litigation, and disciplinary proceedings, Dubey noted that each comes with limitations. “Criminal prosecution is rare, civil cases are slow and evidence-heavy, and disciplinary proceedings do not always ensure compensation or thorough fact-finding,” she said. Compared with Western peers, India faces two major policy gaps in patients’ treatment: the absence of a national electronic medical record (EMR) system, and the lack of a digital system connecting labs directly to the consulting doctor. Currently, India doesn’t have a mandatory EMR policy applicable to healthcare organisations. Even today, prescriptions, clinical notes, and drug administration records are still handwritten in the majority of hospitals and almost all smaller clinics. This makes them more vulnerable to tampering, loss and destruction. The absence of a nationwide electronic medical record system adds another layer of opacity. In many facilities, records remain handwritten and vulnerable to alteration; a gap Bharihoke alleges was evident in Simran’s case. Urgent reform is necessary India’s Minister of Health Jagat Prakash Nadda. Legal experts are calling on authorities to establish an independent statutory body to investigate medical negligence. Only families with the financial means and emotional capacity to pursue long legal battles are able to take up medical negligence cases. For many others, the burden becomes too heavy to carry. While the rules may appear neutral on paper, experts say their impact is deeply unequal. Legal and policy experts argue that the most urgent reform is structural, particularly the creation of an independent statutory body tasked solely with investigating patient safety incidents, particularly in cases involving death, permanent disability, or serious injury. Such a body should have the authority to enter hospital premises, access medical records, secure CCTV footage, and record statements. Its findings should be made public, while the evidence it collects remains protected from use in criminal or disciplinary proceedings. In England, the Health Services Safety Investigations Body (HSSIB), established in 2023, follows this approach by conducting independent investigations into patient safety incidents. Globally, different systems offer alternative approaches to accountability. In the United States, oversight is spread across multiple layers: state medical boards regulate conduct, a national database tracks malpractice records, hospitals report serious incidents, and patients can pursue civil litigation. China follows a three-tier system, allowing patients to first negotiate with hospitals, then seek mediation, and finally pursue civil lawsuits. In parts of Europe, including France and the Nordic countries, no-fault compensation systems allow patients to receive compensation without proving negligence, making the process more accessible and less adversarial. Aviation and rail safety investigations have long operated on similar principles, focusing on systemic failures rather than individual blame. For India, experts say the lesson is clear. Accountability frameworks do not have to rely solely on litigation. A system built on independent investigation, timely access to evidence, and patient-centric redress could help provide answers to families like the Bajajs and Sharmas. Image Credits: César Badilla Miranda/ Unsplash, Felix Sassmannshausen. No Pandemic Agreement Annex by World Health Assembly, Says Civil Society 30/04/2026 Kerry Cullinan (Left to right from top) Third World Network’s moderator and speakers Lauren Paremoer, KP Gopakumar and Tamara Prisenburg form AIDS Healthcare Foundation. The final missing piece of the Pandemic Agreement – a pathogen access and benefit-sharing (PABS) system – is unlikely to be agreed on by the World Health Assembly (WHA) later this month. This was the view of civil society observers of the talks taking place at the World Health Organisation (WHO) headquarters in Geneva, who briefed the media on Thursday. The sixth round of talks is scheduled to end late on Friday night (1 May). Earlier in the week, WHO Director General Dr Tedros Adhanom Ghebreyesus told a Geneva media briefing that “key differences remain on key issues”. “I still see a common will to reach consensus, which means I continue to believe there is a way to reach consensus,” Tedros added. Although the notion of a “hybrid” PABS system is being discussed informally, its proponent, the European Union (EU), has not presented any formal text, Third World Network’s (TWN) KM Gopakumar told the media briefing, which was hosted by TWN and the AIDS Healthcare Foundation. While Brazil and Botswana have apparently indicated that they might support a hybrid or “blended” compromise, the Africa Group is opposed to it, according to the civil society representatives. WHO member states are negotiating how to share both information about dangerous pathogens and some of the “benefits” that manufacturers may develop from that information – namely, vaccines, therapeutics and diagnostics (VTDs). The “hybrid” or “blended” proposal is a mix of mandatory and voluntary measures for sharing pathogen information and any benefits that flow from this information. It de-links information-sharing and benefit-sharing. Gopakumar said that, in terms of the blended agreements, countries that shared pathogens “will have the freedom to choose to attach certain conditions for sharing the data and the sample, including benefit sharing requirements” or share without any conditions. Kill the efficiency Shifting the choice to individual countries would undermine the efficiency of a single PABS system as users would need to negotiate with the individual countries instead of through a centralised system, he argued. “If you have a hybrid system, first of all, it kills the efficiency [of a single system], and second, it’s going to debase the access and benefit sharing norms set by the international instruments like the Convention on Biological Diversity and the Nagoya Protocol. Any attempt to dilute benefit-sharing obligations would be a “disaster” for equity, said AHF’s Tamara Prisenberg. Lauren Paremoer of the People’s Health Movement said that the blended model introduces “a two-track system for accessing pathogens” that violates access and benefit-sharing on an “equal footing” specified in Article 12 of the Pandemic Agreement. One track would allow anonymous users to access pathogen data without upfront commitments to benefit-sharing or legally binding contracts. The other was in line with Article 12, permitting access to pathogens through databases and laboratories that would require users to register and commit to specified benefit-sharing. Earlier in the day, the Intergovernmental Working Group (IGWG) briefed civil society on text-based negotiations, but very little of the text they shared had been “greened” to show agreement. EXCLUSIVE: WHO Opens Nominations for Next Director General; Germany May Advance Former Merkel Aide, Helge Braun 30/04/2026 Felix Sassmannshausen, Elaine Ruth Fletcher & Editorial team WHO DG Dr Tedros Adhanom Ghebreyesus issued a call for nominations for the DG elections. He recently travelled to Berlin, where he met with high-level politicians and the WHO’s Pandemic Intelligence team. As the World Health Organization (WHO) formally opens the nomination process for the next Director-General, Germany now appears likely to propose Helge Braun, Chief of Staff in former Chancellor Angela Merkel’s government, according to Berlin insiders. But after slashing its global health budget, sources question whether a German candidate can win wide support from other WHO member states. WHO Director-General Dr Tedros Adhanom Ghebreyesus has formally issued a call to WHO member states for nominations to the DG elections, scheduled for May 2027, in an invitation sent on 24 April to all WHO member states. WHO confirmed this in an email to Health Policy Watch. The invitations had been sent via private letters to countries’ Geneva missions. The period in which member states may nominate candidates will now run for six months, until 24 September. Contenders who have until now remained in the shadows are expected to begin coming forward publicly with their candidacies at the World Health Assembly in May. From the German perspective, Berlin wants its financial weight reflected in executive influence at the multilateral level as the largest global health donor following the US withdrawal from the WHO in January 2025. The withdrawal, combined with the US non-payment of dues owed, thrust WHO into a budget crisis, prompting layoffs of about 25% of the workforce in the past year. German Foreign Ministry neither confirms nor denies The German Foreign Ministry, formally responsible for the nomination, declined to confirm or comment on Braun’s potential candidacy when responding to a query by Health Policy Watch. Germany’s other potential candidates include the contested former Health Minister Karl Lauterbach and the lesser-known Paul Zubeil. In contrast, Braun’s dual profile as an accomplished politician, skilled financial manager, and trained physician and researcher who successfully built cross-party bridges offers a distinct advantage. But he is little known outside of Germany. Bridge-builder with executive and medical expertise Former Chair of the influential German Budget Committee, Helge Braun (right), and former French Chair of the Finance Committee, Claude Raynal (left), in the Bundestag. The current WHO leadership landscape demands a candidate capable of managing deep institutional fractures and uniting a divided global community. Despite him being largely unknown in the international community, Germany could be expected to emphasise Braun’s extensive fiscal and crisis management experience in any candidacy it mounts. As ‘Head of the Chancellery’, effectively Chief of Staff, in Angela Merkel’s last term as Chancellor, from 2018 to 2021, Braun operated at the nexus of scientific advice and political implementation during the COVID-19 pandemic, notably comparing the Chancellery to an intensive care unit where acute problems must be solved. Between 2021 and 2025, Braun then chaired the powerful Budget Committee of the German Bundestag (Parliament), overseeing the distribution and management of hundreds of billions of Euros with strict discipline This profound understanding of macroeconomic management, coupled with his pragmatic defence of Germany’s controversial debt ceiling alongside crisis-driven special funds, makes him an attractive prospect for donor nations currently demanding more financial accountability and restructuring at WHO in Geneva. Serving as a central mediator across government ministries, Braun built a reputation as a highly pragmatic problem solver whose past domestic political affiliations will not necessarily dictate his future approach to global health governance. This pragmatism complements his longstanding political advocacy for research into infectious diseases like Ebola and malaria. And unlike many career politicians, Braun’s foundational expertise lies in medicine, having worked for years as an intensive care physician and anaesthesiologist. He returned to these roots in April 2025 by assuming the presidency of the University of Lübeck, an institution renowned for its focus on life sciences and artificial intelligence. Why the candidacy might spark concerns WHO member states are currently negotiating a pathogen access and benefit-sharing (PABS) system in Geneva. While Braun championed early interventions and massive digitisation projects in his role as Merkel’s Head of the Chancellery during the COVID pandemic, severe bureaucratic delays hampered the rollout of vaccination campaigns and testing strategies. This tarnished his crisis management legacy just as he exited the federal government. His domestic political capital suffered further damage during the December 2021 Christian Democratic Union leadership election, where he lost heavily to conservative rival Friedrich Merz, now Chancellor. Party members largely rejected Braun as an establishment candidate, perceiving him as too closely aligned with the moderate legacy of former Chancellor Angela Merkel. Additionally, it is questionable whether Braun would wield the necessary diplomatic connections and familiarity with foreign health systems to be effective on Day One of a term as WHO head. The Director-General must immediately command trust and authority on the international stage, particularly when dealing with health ministries and stakeholders in the Global South. Most notably, the German government opposed the release of COVID-19 vaccine patents during his tenure, drawing sharp criticism from international health equity advocates. Defending this refusal in May 2021, Braun wrote in a guest article for the German newspaper Die Zeit that “patent protection as a driver of innovation is not the problem in this crisis, but an essential foundation for its solution.” In the Global South, this track record could thus reinforce the perception that Germany defends pharmaceutical interests over equitable technology transfer – especially in the face of current PABS Annex negotiations. Recent reports from Tagesspiegel Background indicating that the former minister was approached by Germany’s Association of Research-Based Pharmaceutical Companies to become their next president, when the post becomes vacant at the end of 2026, might further fuel these concerns. Finally, Germany has been cutting back its Official Development Assistance (ODA) in general, including contributions to the World Health Organization, where it has historically been the largest member state donor after the United States. On Wednesday, the Merz government announced its 2027 budget plans with further ODA cuts following last year’s drastic 17% reductions. The likelihood of Germany fulfilling its original 2024 financial pledge to WHO for the current biennium (2026-27) also remains in doubt. “They can put forward a candidate, but I don’t think it’s going to get a lot of traction from other member states,” said one informed WHO source. “At a time when Germany is reducing global health funding to member states, I don’t think they can go ahead and claim the top seat.” Step back and support allied candidates? Braun served as Head of Chancellery under then German Chancellor Angela Merkel, seen here with WHO Director General Dr Tedros in Berlin in 2021. Furthermore, domestic opinion remains highly divided on mounting a campaign amidst the geopolitical strains on Chancellor Friedrich Merz’s coalition and Tedros has reportedly urged Germany to back allied candidates instead. At the same time, the desire to seize more leadership in the UN system remains strong after Germany’s failed previous attempt to secure the top role at the UN High Commissioner for Refugees in 2025. Currently, Germany is also pushing for another attempt at a UN Security Council seat. Should Germany put forward a candidate, Foreign Minister Johann Wadephul, who will make the final decision, also faces a stark choice between Braun and the better-known Karl Lauterbach, as well as Paul Zubeil with his strong international health and technical background. Advancing a WHO outsider like Braun against established public health veterans is a highly calculated risk for Berlin, which must first convince other European countries to rally behind him. In case Berlin formally nominates Braun, the success of his candidacy will depend entirely on how effectively the government can reframe his perceived lack of field experience and global networks as delivery on fresh, badly needed fiscal expertise and perspectives. Grappling with WHO’s funding crisis As the race for the next Director-General opens for formal nominations, the names of over a dozen high-profile potential candidates are still circulating – from Indonesia to the United Kingdom. Want to Become the Next WHO Director-General? Get in Line And the list is still growing. Among the newer names being floated is that of Dr Hanan Mohamed al-Kuwari, who served as Qatar’s Minister of Public Health until November 2024 and chaired the 153rd Session of the WHO Executive Board. Before joining the Hamad Medical Corporation in 1996, where she ultimately rose to managing director, al-Kuwari worked for Reuters and as a freelance health reporter. Holding a PhD in healthcare management from Brunel University and bringing early career experience from the WHO, she represents a highly networked voice from the Arab world, celebrated for her crisis resilience and for shaping the WHO’s recent global work programme. Dr Maria Neira, former WHO Director of Climate, Environment and Health Another candidate who has been mentioned is Spain’s Dr Maria Neira, who recently retired from WHO as the director of Climate, Environment and Health. An iconic spokesperson for the climate, environment and health movement, Neira is known as a telegenic personality and adroit politically. As a young medical doctor, she worked in emergency relief in Latin America and Africa, and later served as Spain’s Vice Minister of Health and Consumer Affairs as well as President of the Spanish Food Safety and Nutrition Agency. However, Spain also recently decided to nominate a candidate to head the UN Food and Agriculture Organization (FAO), when Qu Dongyu’s second term as Director General ends in July 2027, leaving doubts about whether it would want to mount yet another campaign, in parallel. Continuing decline in ODA and global health aid Drastic ODA cuts and reduced global health funding leave vulnerable populations in precarious conditions worldwide. Whoever is elected will have to continue grappling with the continuing long-term declines in donor-driven ODA, and particularly global health aid – directly to countries and to WHO. While WHO 2026-2027 $4.2 billion base budget is now 85% financed, according to Tedros’ comments on Wednesday, declines in ODA continue to cast uncertainty on how the remaining $630 million gap will be filled. It’s unlikely that the $260.6 million in assessed US contributions still due for years 2024-2025, before the withdrawal became official in January, will ever be repaid, conceded WHO’s Tedros at a Geneva press briefing on Wednesday. “We’re hoping to get the money, but no signals yet,” Tedros told journalists, adding: “No signals means maybe we may not be able to get the money. The likelihood could be not getting the money.” “We’re looking at nontraditional donors. We’re looking at international financial institutions and other ways to mobilize that 15%,” Tedros said, in terms of filling that gap. “It’s not that we won’t go to the traditional donors, but I think we’re expanding that donor base.” This article has been edited to reflect additional information regarding Dr Hanan Mohamed al-Kuwari’s early career as a freelance journalist. Image Credits: X/Dr Tedros, Deutscher Bundestag/Leon Kügeler, European Commission. Posts navigation Older posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy Loading Comments... You must be logged in to post a comment.
Heartbroken Families Face Huge Structural Barriers When Trying to Prove Medical Negligence in India 01/05/2026 Arsalan Bukhari & Naila Tabassum Indian families face a huge struggle to get timely access to medical records of loved ones who have died in Indian health facilities, while the police can only lay a charge against a doctor if an independent medical expert first confirms negligence. NEW DELHI – India faces thousands of medical negligence cases every year, but structural problems make it extremely difficult for patients’ families to find out what has happened to their loved ones – let alone win compensation when treatment has been botched. “A shadow of death is looming over us,” Ashwini Bajaj, a Haryana-based businessman, told Health Policy Watch, recalling the treatment of his 24-year-old son, Deshbandhu, more than a year after his death. In December 2024, Deshbandhu, an MBA student at Punjab University and Bajaj’s only son, developed a fever that lasted more than two days. On 26 December, he visited a hospital near his university in Chandigarh, where he was prescribed medicines and given a series of tests, including a liver function test (LFT). By the time the results came out later that evening, Deshbandhu had returned to his parents’ home in Hisar, around 200 kilometres away. The next day, he went to a private hospital there, but his condition deteriorated rapidly. His oxygen saturation dropped to 65%, and doctors warned of acute liver failure. “We were told his condition was very critical and that the hospital did not have the resources to treat him,” Bajaj said. “We were asked to take him to a super-speciality hospital. It felt as if the ground beneath our feet had slipped away.” Deshbandhu was shifted to a major private hospital in Gurugram. “My son was there for over three weeks. His condition kept deteriorating. He went with jaundice, and he developed intestinal obstruction, kidney stress, and pneumonia,” Bajaj said. A few days after his 24th birthday, which was on 20 January 2025, Deshbandhu died. Bajaj says he has been unable to return to work. His case reflects broader systemic gaps in India’s healthcare system, where delays in critical care, weak referral systems, and limited transparency can have life-threatening consequences — and the lack of updated national data continues to hamper accountability. Transparency in treatment Deshbandhu Bajaj (24), a mountaineer and an MBA student who died in January 2025. His father, Ashwini Bajaj, alleges medical negligence. “Initially, I thought the doctors tried hard to save my child, but when I obtained all the medical reports, which took three to four months to obtain, I realised much time was lost before the actual treatment started,” Bajaj said. “When I made a day-by-day chart, I realised that, for at least four days, my son didn’t get the treatment he should have. “Every evening, I used to get payment requests promptly on my WhatsApp. If they could send payment requests, why can’t they share procedural updates the same way?” Rujhan Dhawan, a lawyer at the Punjab and Haryana High Court, told Health Policy Watch such opacity is a major barrier to accountability. “A patient, once admitted, is entirely dependent on the institution not only for treatment but also for truthful disclosure,” he said. “Critical information about procedures and complications is often not readily accessible to families.” Bajaj’s family spent over ₹30 lakh ($33,000) on treatment. He says he is not seeking compensation, but a legal framework that mandates transparency. Not an isolated case Deshbandhu’s case is not an isolated one. According to the 18th Annual MedLegal Review, 65,000 medical negligence cases were filed in India in 2025 alone. Radha Sharma (49), a resident of Rajasthan’s capital city Jaipur, died days after being given a TB drugs although she had been diagnosed with a liver-related illness. In Jaipar, around 270 kilometres from Gurugram, 55-year-old tax consultant Kishan Kumar Sharma is fighting a case linked to the death of his wife, Radha. On 3 March 2025, she developed mild jaundice and was admitted to a private hospital. A test suggested Budd-Chiari syndrome, a rare liver disorder. However, despite a negative tuberculosis test, Radha was prescribed the TB drug, Isoniazid, said Sharma. Isoniazid should not be prescribed to patients with liver disease who have bilirubin levels over 4 mg/dL, according to World Health Organization (WHO) guidelines. But Sharma says his wife’s liver disorder was overlooked. Radha’s condition deteriorated rapidly, and she died on 18 March. “I have a simple question,” Sharma said. “Why was my wife given Isoniazid? Was it part of any established protocol or something else?” The risks highlighted by such cases reflect a broader global problem. According to the WHO, an estimated 138 million patients are harmed every year due to unsafe medical care. Lack of dedicated investigative body Nishant Bharihoke, an advocate at the Delhi High Court who specialises in medical negligence cases, told Health Policy Watch the core issue lies in the absence of a dedicated independent investigative framework. “India does not have a dedicated body specifically tasked with investigating deaths or serious injuries caused by medical negligence,” he said. “When a patient dies, and the family suspects wrongdoing, there is no authority whose sole function is to find out what happened.” Complaints are typically routed through State Medical Councils, which may form inquiry committees. Their decisions can be appealed to the National Medical Commission, but Bharihoke argues that the system is structurally limited. “The National Medical Commission’s primary mandate is to regulate medical education. Its disciplinary board has no independent investigators and no power to enter hospitals and examine evidence,” he said. He also pointed to a legal loophole: since these proceedings are not strictly judicial, false statements made before such bodies do not result in perjury charges. For families like Bajaj’s and Sharma’s, he said, this gap deepens the sense of injustice. When cases turn criminal Simran Chhabra (21), a resident of Gurugram and MA student at Amity University, was suffering from a simple cough and cold. She died within minutes of being administered an intravenous injection. The family is fighting a medical negligence case in a Gurugram court. The gap becomes even wider when negligence overlaps with criminal allegations. One such case is the death of 21-year-old Simran Chhabra. On 21 January 2023, she visited a private hospital in Gurugram with symptoms of cough and cold. According to a prescription her brother, Sourabh Chhabra, shared with Health Policy Watch, she was administered an intravenous injection of Dynapar. This is usually used to treat pain and inflammation associated with arthritis or after surgery. “As soon as the injection was fully administered, Simran collapsed on the bed and froth began coming out of her mouth,” Sourabh said. “Everything happened within minutes. I had no time to understand what was going on.” She was referred to another hospital, where she was declared dead. According to Bharihoke, the family’s legal representative, the doctor later claimed that multiple emergency interventions were carried out, including five additional injections and cardiopulmonary resuscitation (CPR), using drugs typically administered in cases of severe allergic reactions. However, the post-mortem report reviewed by Health Policy Watch raises questions. It records only two puncture marks on her body, and there is no mention of a cannula (an intravenous tube) being used. If multiple injections were administered, the family asks why there is no corresponding physical evidence. In this case, they argue, the medical account and post-mortem findings do not align. “Forget conviction or arrest, even registering an FIR in such cases often requires court intervention,” Bharihoke said. A FIR is a First Information Report (FIR) in Indian medical negligence cases, a formal document prepared by police under Section 154 of the Criminal Procedure Code upon receiving information about alleged criminal negligence. Absence of a legal framework Several structural barriers insulate medical health practitioners against negligence cases, according to legal experts. “In India, police usually cannot even register a case against a doctor unless an independent medical expert first confirms negligence,” Bharihoke told Health Policy Watch. “In most cases, doctors are reluctant to give such opinions, especially against their peers.” The challenge is compounded by access to evidence. Hospitals retain control over key records, case files, prescriptions, nursing notes, and CCTV footage while families often receive only partial or delayed documentation. India also lacks a statutory system guaranteeing timely access to medical records for patients and their families. There is no clear legal mandate requiring investigators to immediately secure hospital evidence. Tanvi Dubey, a Supreme Court lawyer, told Health Policy Watch the legal framework itself raises the bar for accountability. “Criminal liability in medical negligence cases is limited to gross negligence, not simple errors of judgment,” Dubey said. “This significantly narrows the scope for prosecution.” Even initiating an investigation can be delayed: “Authorities are allowed to conduct preliminary inquiries before registering a case, which often means waiting for medical opinions and slows the process.” Dubey also pointed to the continued reliance on what is known in Indian law as the “Bolam principle,” where a doctor’s actions are judged against a body of medical opinion. “This makes expert testimony central. Unless a complainant can produce strong contrary evidence, it becomes very difficult to establish negligence,” she said. While multiple legal remedies exist, including consumer courts, civil litigation, and disciplinary proceedings, Dubey noted that each comes with limitations. “Criminal prosecution is rare, civil cases are slow and evidence-heavy, and disciplinary proceedings do not always ensure compensation or thorough fact-finding,” she said. Compared with Western peers, India faces two major policy gaps in patients’ treatment: the absence of a national electronic medical record (EMR) system, and the lack of a digital system connecting labs directly to the consulting doctor. Currently, India doesn’t have a mandatory EMR policy applicable to healthcare organisations. Even today, prescriptions, clinical notes, and drug administration records are still handwritten in the majority of hospitals and almost all smaller clinics. This makes them more vulnerable to tampering, loss and destruction. The absence of a nationwide electronic medical record system adds another layer of opacity. In many facilities, records remain handwritten and vulnerable to alteration; a gap Bharihoke alleges was evident in Simran’s case. Urgent reform is necessary India’s Minister of Health Jagat Prakash Nadda. Legal experts are calling on authorities to establish an independent statutory body to investigate medical negligence. Only families with the financial means and emotional capacity to pursue long legal battles are able to take up medical negligence cases. For many others, the burden becomes too heavy to carry. While the rules may appear neutral on paper, experts say their impact is deeply unequal. Legal and policy experts argue that the most urgent reform is structural, particularly the creation of an independent statutory body tasked solely with investigating patient safety incidents, particularly in cases involving death, permanent disability, or serious injury. Such a body should have the authority to enter hospital premises, access medical records, secure CCTV footage, and record statements. Its findings should be made public, while the evidence it collects remains protected from use in criminal or disciplinary proceedings. In England, the Health Services Safety Investigations Body (HSSIB), established in 2023, follows this approach by conducting independent investigations into patient safety incidents. Globally, different systems offer alternative approaches to accountability. In the United States, oversight is spread across multiple layers: state medical boards regulate conduct, a national database tracks malpractice records, hospitals report serious incidents, and patients can pursue civil litigation. China follows a three-tier system, allowing patients to first negotiate with hospitals, then seek mediation, and finally pursue civil lawsuits. In parts of Europe, including France and the Nordic countries, no-fault compensation systems allow patients to receive compensation without proving negligence, making the process more accessible and less adversarial. Aviation and rail safety investigations have long operated on similar principles, focusing on systemic failures rather than individual blame. For India, experts say the lesson is clear. Accountability frameworks do not have to rely solely on litigation. A system built on independent investigation, timely access to evidence, and patient-centric redress could help provide answers to families like the Bajajs and Sharmas. Image Credits: César Badilla Miranda/ Unsplash, Felix Sassmannshausen. No Pandemic Agreement Annex by World Health Assembly, Says Civil Society 30/04/2026 Kerry Cullinan (Left to right from top) Third World Network’s moderator and speakers Lauren Paremoer, KP Gopakumar and Tamara Prisenburg form AIDS Healthcare Foundation. The final missing piece of the Pandemic Agreement – a pathogen access and benefit-sharing (PABS) system – is unlikely to be agreed on by the World Health Assembly (WHA) later this month. This was the view of civil society observers of the talks taking place at the World Health Organisation (WHO) headquarters in Geneva, who briefed the media on Thursday. The sixth round of talks is scheduled to end late on Friday night (1 May). Earlier in the week, WHO Director General Dr Tedros Adhanom Ghebreyesus told a Geneva media briefing that “key differences remain on key issues”. “I still see a common will to reach consensus, which means I continue to believe there is a way to reach consensus,” Tedros added. Although the notion of a “hybrid” PABS system is being discussed informally, its proponent, the European Union (EU), has not presented any formal text, Third World Network’s (TWN) KM Gopakumar told the media briefing, which was hosted by TWN and the AIDS Healthcare Foundation. While Brazil and Botswana have apparently indicated that they might support a hybrid or “blended” compromise, the Africa Group is opposed to it, according to the civil society representatives. WHO member states are negotiating how to share both information about dangerous pathogens and some of the “benefits” that manufacturers may develop from that information – namely, vaccines, therapeutics and diagnostics (VTDs). The “hybrid” or “blended” proposal is a mix of mandatory and voluntary measures for sharing pathogen information and any benefits that flow from this information. It de-links information-sharing and benefit-sharing. Gopakumar said that, in terms of the blended agreements, countries that shared pathogens “will have the freedom to choose to attach certain conditions for sharing the data and the sample, including benefit sharing requirements” or share without any conditions. Kill the efficiency Shifting the choice to individual countries would undermine the efficiency of a single PABS system as users would need to negotiate with the individual countries instead of through a centralised system, he argued. “If you have a hybrid system, first of all, it kills the efficiency [of a single system], and second, it’s going to debase the access and benefit sharing norms set by the international instruments like the Convention on Biological Diversity and the Nagoya Protocol. Any attempt to dilute benefit-sharing obligations would be a “disaster” for equity, said AHF’s Tamara Prisenberg. Lauren Paremoer of the People’s Health Movement said that the blended model introduces “a two-track system for accessing pathogens” that violates access and benefit-sharing on an “equal footing” specified in Article 12 of the Pandemic Agreement. One track would allow anonymous users to access pathogen data without upfront commitments to benefit-sharing or legally binding contracts. The other was in line with Article 12, permitting access to pathogens through databases and laboratories that would require users to register and commit to specified benefit-sharing. Earlier in the day, the Intergovernmental Working Group (IGWG) briefed civil society on text-based negotiations, but very little of the text they shared had been “greened” to show agreement. EXCLUSIVE: WHO Opens Nominations for Next Director General; Germany May Advance Former Merkel Aide, Helge Braun 30/04/2026 Felix Sassmannshausen, Elaine Ruth Fletcher & Editorial team WHO DG Dr Tedros Adhanom Ghebreyesus issued a call for nominations for the DG elections. He recently travelled to Berlin, where he met with high-level politicians and the WHO’s Pandemic Intelligence team. As the World Health Organization (WHO) formally opens the nomination process for the next Director-General, Germany now appears likely to propose Helge Braun, Chief of Staff in former Chancellor Angela Merkel’s government, according to Berlin insiders. But after slashing its global health budget, sources question whether a German candidate can win wide support from other WHO member states. WHO Director-General Dr Tedros Adhanom Ghebreyesus has formally issued a call to WHO member states for nominations to the DG elections, scheduled for May 2027, in an invitation sent on 24 April to all WHO member states. WHO confirmed this in an email to Health Policy Watch. The invitations had been sent via private letters to countries’ Geneva missions. The period in which member states may nominate candidates will now run for six months, until 24 September. Contenders who have until now remained in the shadows are expected to begin coming forward publicly with their candidacies at the World Health Assembly in May. From the German perspective, Berlin wants its financial weight reflected in executive influence at the multilateral level as the largest global health donor following the US withdrawal from the WHO in January 2025. The withdrawal, combined with the US non-payment of dues owed, thrust WHO into a budget crisis, prompting layoffs of about 25% of the workforce in the past year. German Foreign Ministry neither confirms nor denies The German Foreign Ministry, formally responsible for the nomination, declined to confirm or comment on Braun’s potential candidacy when responding to a query by Health Policy Watch. Germany’s other potential candidates include the contested former Health Minister Karl Lauterbach and the lesser-known Paul Zubeil. In contrast, Braun’s dual profile as an accomplished politician, skilled financial manager, and trained physician and researcher who successfully built cross-party bridges offers a distinct advantage. But he is little known outside of Germany. Bridge-builder with executive and medical expertise Former Chair of the influential German Budget Committee, Helge Braun (right), and former French Chair of the Finance Committee, Claude Raynal (left), in the Bundestag. The current WHO leadership landscape demands a candidate capable of managing deep institutional fractures and uniting a divided global community. Despite him being largely unknown in the international community, Germany could be expected to emphasise Braun’s extensive fiscal and crisis management experience in any candidacy it mounts. As ‘Head of the Chancellery’, effectively Chief of Staff, in Angela Merkel’s last term as Chancellor, from 2018 to 2021, Braun operated at the nexus of scientific advice and political implementation during the COVID-19 pandemic, notably comparing the Chancellery to an intensive care unit where acute problems must be solved. Between 2021 and 2025, Braun then chaired the powerful Budget Committee of the German Bundestag (Parliament), overseeing the distribution and management of hundreds of billions of Euros with strict discipline This profound understanding of macroeconomic management, coupled with his pragmatic defence of Germany’s controversial debt ceiling alongside crisis-driven special funds, makes him an attractive prospect for donor nations currently demanding more financial accountability and restructuring at WHO in Geneva. Serving as a central mediator across government ministries, Braun built a reputation as a highly pragmatic problem solver whose past domestic political affiliations will not necessarily dictate his future approach to global health governance. This pragmatism complements his longstanding political advocacy for research into infectious diseases like Ebola and malaria. And unlike many career politicians, Braun’s foundational expertise lies in medicine, having worked for years as an intensive care physician and anaesthesiologist. He returned to these roots in April 2025 by assuming the presidency of the University of Lübeck, an institution renowned for its focus on life sciences and artificial intelligence. Why the candidacy might spark concerns WHO member states are currently negotiating a pathogen access and benefit-sharing (PABS) system in Geneva. While Braun championed early interventions and massive digitisation projects in his role as Merkel’s Head of the Chancellery during the COVID pandemic, severe bureaucratic delays hampered the rollout of vaccination campaigns and testing strategies. This tarnished his crisis management legacy just as he exited the federal government. His domestic political capital suffered further damage during the December 2021 Christian Democratic Union leadership election, where he lost heavily to conservative rival Friedrich Merz, now Chancellor. Party members largely rejected Braun as an establishment candidate, perceiving him as too closely aligned with the moderate legacy of former Chancellor Angela Merkel. Additionally, it is questionable whether Braun would wield the necessary diplomatic connections and familiarity with foreign health systems to be effective on Day One of a term as WHO head. The Director-General must immediately command trust and authority on the international stage, particularly when dealing with health ministries and stakeholders in the Global South. Most notably, the German government opposed the release of COVID-19 vaccine patents during his tenure, drawing sharp criticism from international health equity advocates. Defending this refusal in May 2021, Braun wrote in a guest article for the German newspaper Die Zeit that “patent protection as a driver of innovation is not the problem in this crisis, but an essential foundation for its solution.” In the Global South, this track record could thus reinforce the perception that Germany defends pharmaceutical interests over equitable technology transfer – especially in the face of current PABS Annex negotiations. Recent reports from Tagesspiegel Background indicating that the former minister was approached by Germany’s Association of Research-Based Pharmaceutical Companies to become their next president, when the post becomes vacant at the end of 2026, might further fuel these concerns. Finally, Germany has been cutting back its Official Development Assistance (ODA) in general, including contributions to the World Health Organization, where it has historically been the largest member state donor after the United States. On Wednesday, the Merz government announced its 2027 budget plans with further ODA cuts following last year’s drastic 17% reductions. The likelihood of Germany fulfilling its original 2024 financial pledge to WHO for the current biennium (2026-27) also remains in doubt. “They can put forward a candidate, but I don’t think it’s going to get a lot of traction from other member states,” said one informed WHO source. “At a time when Germany is reducing global health funding to member states, I don’t think they can go ahead and claim the top seat.” Step back and support allied candidates? Braun served as Head of Chancellery under then German Chancellor Angela Merkel, seen here with WHO Director General Dr Tedros in Berlin in 2021. Furthermore, domestic opinion remains highly divided on mounting a campaign amidst the geopolitical strains on Chancellor Friedrich Merz’s coalition and Tedros has reportedly urged Germany to back allied candidates instead. At the same time, the desire to seize more leadership in the UN system remains strong after Germany’s failed previous attempt to secure the top role at the UN High Commissioner for Refugees in 2025. Currently, Germany is also pushing for another attempt at a UN Security Council seat. Should Germany put forward a candidate, Foreign Minister Johann Wadephul, who will make the final decision, also faces a stark choice between Braun and the better-known Karl Lauterbach, as well as Paul Zubeil with his strong international health and technical background. Advancing a WHO outsider like Braun against established public health veterans is a highly calculated risk for Berlin, which must first convince other European countries to rally behind him. In case Berlin formally nominates Braun, the success of his candidacy will depend entirely on how effectively the government can reframe his perceived lack of field experience and global networks as delivery on fresh, badly needed fiscal expertise and perspectives. Grappling with WHO’s funding crisis As the race for the next Director-General opens for formal nominations, the names of over a dozen high-profile potential candidates are still circulating – from Indonesia to the United Kingdom. Want to Become the Next WHO Director-General? Get in Line And the list is still growing. Among the newer names being floated is that of Dr Hanan Mohamed al-Kuwari, who served as Qatar’s Minister of Public Health until November 2024 and chaired the 153rd Session of the WHO Executive Board. Before joining the Hamad Medical Corporation in 1996, where she ultimately rose to managing director, al-Kuwari worked for Reuters and as a freelance health reporter. Holding a PhD in healthcare management from Brunel University and bringing early career experience from the WHO, she represents a highly networked voice from the Arab world, celebrated for her crisis resilience and for shaping the WHO’s recent global work programme. Dr Maria Neira, former WHO Director of Climate, Environment and Health Another candidate who has been mentioned is Spain’s Dr Maria Neira, who recently retired from WHO as the director of Climate, Environment and Health. An iconic spokesperson for the climate, environment and health movement, Neira is known as a telegenic personality and adroit politically. As a young medical doctor, she worked in emergency relief in Latin America and Africa, and later served as Spain’s Vice Minister of Health and Consumer Affairs as well as President of the Spanish Food Safety and Nutrition Agency. However, Spain also recently decided to nominate a candidate to head the UN Food and Agriculture Organization (FAO), when Qu Dongyu’s second term as Director General ends in July 2027, leaving doubts about whether it would want to mount yet another campaign, in parallel. Continuing decline in ODA and global health aid Drastic ODA cuts and reduced global health funding leave vulnerable populations in precarious conditions worldwide. Whoever is elected will have to continue grappling with the continuing long-term declines in donor-driven ODA, and particularly global health aid – directly to countries and to WHO. While WHO 2026-2027 $4.2 billion base budget is now 85% financed, according to Tedros’ comments on Wednesday, declines in ODA continue to cast uncertainty on how the remaining $630 million gap will be filled. It’s unlikely that the $260.6 million in assessed US contributions still due for years 2024-2025, before the withdrawal became official in January, will ever be repaid, conceded WHO’s Tedros at a Geneva press briefing on Wednesday. “We’re hoping to get the money, but no signals yet,” Tedros told journalists, adding: “No signals means maybe we may not be able to get the money. The likelihood could be not getting the money.” “We’re looking at nontraditional donors. We’re looking at international financial institutions and other ways to mobilize that 15%,” Tedros said, in terms of filling that gap. “It’s not that we won’t go to the traditional donors, but I think we’re expanding that donor base.” This article has been edited to reflect additional information regarding Dr Hanan Mohamed al-Kuwari’s early career as a freelance journalist. Image Credits: X/Dr Tedros, Deutscher Bundestag/Leon Kügeler, European Commission. 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No Pandemic Agreement Annex by World Health Assembly, Says Civil Society 30/04/2026 Kerry Cullinan (Left to right from top) Third World Network’s moderator and speakers Lauren Paremoer, KP Gopakumar and Tamara Prisenburg form AIDS Healthcare Foundation. The final missing piece of the Pandemic Agreement – a pathogen access and benefit-sharing (PABS) system – is unlikely to be agreed on by the World Health Assembly (WHA) later this month. This was the view of civil society observers of the talks taking place at the World Health Organisation (WHO) headquarters in Geneva, who briefed the media on Thursday. The sixth round of talks is scheduled to end late on Friday night (1 May). Earlier in the week, WHO Director General Dr Tedros Adhanom Ghebreyesus told a Geneva media briefing that “key differences remain on key issues”. “I still see a common will to reach consensus, which means I continue to believe there is a way to reach consensus,” Tedros added. Although the notion of a “hybrid” PABS system is being discussed informally, its proponent, the European Union (EU), has not presented any formal text, Third World Network’s (TWN) KM Gopakumar told the media briefing, which was hosted by TWN and the AIDS Healthcare Foundation. While Brazil and Botswana have apparently indicated that they might support a hybrid or “blended” compromise, the Africa Group is opposed to it, according to the civil society representatives. WHO member states are negotiating how to share both information about dangerous pathogens and some of the “benefits” that manufacturers may develop from that information – namely, vaccines, therapeutics and diagnostics (VTDs). The “hybrid” or “blended” proposal is a mix of mandatory and voluntary measures for sharing pathogen information and any benefits that flow from this information. It de-links information-sharing and benefit-sharing. Gopakumar said that, in terms of the blended agreements, countries that shared pathogens “will have the freedom to choose to attach certain conditions for sharing the data and the sample, including benefit sharing requirements” or share without any conditions. Kill the efficiency Shifting the choice to individual countries would undermine the efficiency of a single PABS system as users would need to negotiate with the individual countries instead of through a centralised system, he argued. “If you have a hybrid system, first of all, it kills the efficiency [of a single system], and second, it’s going to debase the access and benefit sharing norms set by the international instruments like the Convention on Biological Diversity and the Nagoya Protocol. Any attempt to dilute benefit-sharing obligations would be a “disaster” for equity, said AHF’s Tamara Prisenberg. Lauren Paremoer of the People’s Health Movement said that the blended model introduces “a two-track system for accessing pathogens” that violates access and benefit-sharing on an “equal footing” specified in Article 12 of the Pandemic Agreement. One track would allow anonymous users to access pathogen data without upfront commitments to benefit-sharing or legally binding contracts. The other was in line with Article 12, permitting access to pathogens through databases and laboratories that would require users to register and commit to specified benefit-sharing. Earlier in the day, the Intergovernmental Working Group (IGWG) briefed civil society on text-based negotiations, but very little of the text they shared had been “greened” to show agreement. EXCLUSIVE: WHO Opens Nominations for Next Director General; Germany May Advance Former Merkel Aide, Helge Braun 30/04/2026 Felix Sassmannshausen, Elaine Ruth Fletcher & Editorial team WHO DG Dr Tedros Adhanom Ghebreyesus issued a call for nominations for the DG elections. He recently travelled to Berlin, where he met with high-level politicians and the WHO’s Pandemic Intelligence team. As the World Health Organization (WHO) formally opens the nomination process for the next Director-General, Germany now appears likely to propose Helge Braun, Chief of Staff in former Chancellor Angela Merkel’s government, according to Berlin insiders. But after slashing its global health budget, sources question whether a German candidate can win wide support from other WHO member states. WHO Director-General Dr Tedros Adhanom Ghebreyesus has formally issued a call to WHO member states for nominations to the DG elections, scheduled for May 2027, in an invitation sent on 24 April to all WHO member states. WHO confirmed this in an email to Health Policy Watch. The invitations had been sent via private letters to countries’ Geneva missions. The period in which member states may nominate candidates will now run for six months, until 24 September. Contenders who have until now remained in the shadows are expected to begin coming forward publicly with their candidacies at the World Health Assembly in May. From the German perspective, Berlin wants its financial weight reflected in executive influence at the multilateral level as the largest global health donor following the US withdrawal from the WHO in January 2025. The withdrawal, combined with the US non-payment of dues owed, thrust WHO into a budget crisis, prompting layoffs of about 25% of the workforce in the past year. German Foreign Ministry neither confirms nor denies The German Foreign Ministry, formally responsible for the nomination, declined to confirm or comment on Braun’s potential candidacy when responding to a query by Health Policy Watch. Germany’s other potential candidates include the contested former Health Minister Karl Lauterbach and the lesser-known Paul Zubeil. In contrast, Braun’s dual profile as an accomplished politician, skilled financial manager, and trained physician and researcher who successfully built cross-party bridges offers a distinct advantage. But he is little known outside of Germany. Bridge-builder with executive and medical expertise Former Chair of the influential German Budget Committee, Helge Braun (right), and former French Chair of the Finance Committee, Claude Raynal (left), in the Bundestag. The current WHO leadership landscape demands a candidate capable of managing deep institutional fractures and uniting a divided global community. Despite him being largely unknown in the international community, Germany could be expected to emphasise Braun’s extensive fiscal and crisis management experience in any candidacy it mounts. As ‘Head of the Chancellery’, effectively Chief of Staff, in Angela Merkel’s last term as Chancellor, from 2018 to 2021, Braun operated at the nexus of scientific advice and political implementation during the COVID-19 pandemic, notably comparing the Chancellery to an intensive care unit where acute problems must be solved. Between 2021 and 2025, Braun then chaired the powerful Budget Committee of the German Bundestag (Parliament), overseeing the distribution and management of hundreds of billions of Euros with strict discipline This profound understanding of macroeconomic management, coupled with his pragmatic defence of Germany’s controversial debt ceiling alongside crisis-driven special funds, makes him an attractive prospect for donor nations currently demanding more financial accountability and restructuring at WHO in Geneva. Serving as a central mediator across government ministries, Braun built a reputation as a highly pragmatic problem solver whose past domestic political affiliations will not necessarily dictate his future approach to global health governance. This pragmatism complements his longstanding political advocacy for research into infectious diseases like Ebola and malaria. And unlike many career politicians, Braun’s foundational expertise lies in medicine, having worked for years as an intensive care physician and anaesthesiologist. He returned to these roots in April 2025 by assuming the presidency of the University of Lübeck, an institution renowned for its focus on life sciences and artificial intelligence. Why the candidacy might spark concerns WHO member states are currently negotiating a pathogen access and benefit-sharing (PABS) system in Geneva. While Braun championed early interventions and massive digitisation projects in his role as Merkel’s Head of the Chancellery during the COVID pandemic, severe bureaucratic delays hampered the rollout of vaccination campaigns and testing strategies. This tarnished his crisis management legacy just as he exited the federal government. His domestic political capital suffered further damage during the December 2021 Christian Democratic Union leadership election, where he lost heavily to conservative rival Friedrich Merz, now Chancellor. Party members largely rejected Braun as an establishment candidate, perceiving him as too closely aligned with the moderate legacy of former Chancellor Angela Merkel. Additionally, it is questionable whether Braun would wield the necessary diplomatic connections and familiarity with foreign health systems to be effective on Day One of a term as WHO head. The Director-General must immediately command trust and authority on the international stage, particularly when dealing with health ministries and stakeholders in the Global South. Most notably, the German government opposed the release of COVID-19 vaccine patents during his tenure, drawing sharp criticism from international health equity advocates. Defending this refusal in May 2021, Braun wrote in a guest article for the German newspaper Die Zeit that “patent protection as a driver of innovation is not the problem in this crisis, but an essential foundation for its solution.” In the Global South, this track record could thus reinforce the perception that Germany defends pharmaceutical interests over equitable technology transfer – especially in the face of current PABS Annex negotiations. Recent reports from Tagesspiegel Background indicating that the former minister was approached by Germany’s Association of Research-Based Pharmaceutical Companies to become their next president, when the post becomes vacant at the end of 2026, might further fuel these concerns. Finally, Germany has been cutting back its Official Development Assistance (ODA) in general, including contributions to the World Health Organization, where it has historically been the largest member state donor after the United States. On Wednesday, the Merz government announced its 2027 budget plans with further ODA cuts following last year’s drastic 17% reductions. The likelihood of Germany fulfilling its original 2024 financial pledge to WHO for the current biennium (2026-27) also remains in doubt. “They can put forward a candidate, but I don’t think it’s going to get a lot of traction from other member states,” said one informed WHO source. “At a time when Germany is reducing global health funding to member states, I don’t think they can go ahead and claim the top seat.” Step back and support allied candidates? Braun served as Head of Chancellery under then German Chancellor Angela Merkel, seen here with WHO Director General Dr Tedros in Berlin in 2021. Furthermore, domestic opinion remains highly divided on mounting a campaign amidst the geopolitical strains on Chancellor Friedrich Merz’s coalition and Tedros has reportedly urged Germany to back allied candidates instead. At the same time, the desire to seize more leadership in the UN system remains strong after Germany’s failed previous attempt to secure the top role at the UN High Commissioner for Refugees in 2025. Currently, Germany is also pushing for another attempt at a UN Security Council seat. Should Germany put forward a candidate, Foreign Minister Johann Wadephul, who will make the final decision, also faces a stark choice between Braun and the better-known Karl Lauterbach, as well as Paul Zubeil with his strong international health and technical background. Advancing a WHO outsider like Braun against established public health veterans is a highly calculated risk for Berlin, which must first convince other European countries to rally behind him. In case Berlin formally nominates Braun, the success of his candidacy will depend entirely on how effectively the government can reframe his perceived lack of field experience and global networks as delivery on fresh, badly needed fiscal expertise and perspectives. Grappling with WHO’s funding crisis As the race for the next Director-General opens for formal nominations, the names of over a dozen high-profile potential candidates are still circulating – from Indonesia to the United Kingdom. Want to Become the Next WHO Director-General? Get in Line And the list is still growing. Among the newer names being floated is that of Dr Hanan Mohamed al-Kuwari, who served as Qatar’s Minister of Public Health until November 2024 and chaired the 153rd Session of the WHO Executive Board. Before joining the Hamad Medical Corporation in 1996, where she ultimately rose to managing director, al-Kuwari worked for Reuters and as a freelance health reporter. Holding a PhD in healthcare management from Brunel University and bringing early career experience from the WHO, she represents a highly networked voice from the Arab world, celebrated for her crisis resilience and for shaping the WHO’s recent global work programme. Dr Maria Neira, former WHO Director of Climate, Environment and Health Another candidate who has been mentioned is Spain’s Dr Maria Neira, who recently retired from WHO as the director of Climate, Environment and Health. An iconic spokesperson for the climate, environment and health movement, Neira is known as a telegenic personality and adroit politically. As a young medical doctor, she worked in emergency relief in Latin America and Africa, and later served as Spain’s Vice Minister of Health and Consumer Affairs as well as President of the Spanish Food Safety and Nutrition Agency. However, Spain also recently decided to nominate a candidate to head the UN Food and Agriculture Organization (FAO), when Qu Dongyu’s second term as Director General ends in July 2027, leaving doubts about whether it would want to mount yet another campaign, in parallel. Continuing decline in ODA and global health aid Drastic ODA cuts and reduced global health funding leave vulnerable populations in precarious conditions worldwide. Whoever is elected will have to continue grappling with the continuing long-term declines in donor-driven ODA, and particularly global health aid – directly to countries and to WHO. While WHO 2026-2027 $4.2 billion base budget is now 85% financed, according to Tedros’ comments on Wednesday, declines in ODA continue to cast uncertainty on how the remaining $630 million gap will be filled. It’s unlikely that the $260.6 million in assessed US contributions still due for years 2024-2025, before the withdrawal became official in January, will ever be repaid, conceded WHO’s Tedros at a Geneva press briefing on Wednesday. “We’re hoping to get the money, but no signals yet,” Tedros told journalists, adding: “No signals means maybe we may not be able to get the money. The likelihood could be not getting the money.” “We’re looking at nontraditional donors. We’re looking at international financial institutions and other ways to mobilize that 15%,” Tedros said, in terms of filling that gap. “It’s not that we won’t go to the traditional donors, but I think we’re expanding that donor base.” This article has been edited to reflect additional information regarding Dr Hanan Mohamed al-Kuwari’s early career as a freelance journalist. Image Credits: X/Dr Tedros, Deutscher Bundestag/Leon Kügeler, European Commission. Posts navigation Older posts This site uses cookies to help give you the best experience on our website. Cookies enable us to collect information that helps us personalise your experience and improve the functionality and performance of our site. By continuing to read our website, we assume you agree to this, otherwise you can adjust your browser settings. Please read our cookie and Privacy Policy. Our Cookies and Privacy Policy
EXCLUSIVE: WHO Opens Nominations for Next Director General; Germany May Advance Former Merkel Aide, Helge Braun 30/04/2026 Felix Sassmannshausen, Elaine Ruth Fletcher & Editorial team WHO DG Dr Tedros Adhanom Ghebreyesus issued a call for nominations for the DG elections. He recently travelled to Berlin, where he met with high-level politicians and the WHO’s Pandemic Intelligence team. As the World Health Organization (WHO) formally opens the nomination process for the next Director-General, Germany now appears likely to propose Helge Braun, Chief of Staff in former Chancellor Angela Merkel’s government, according to Berlin insiders. But after slashing its global health budget, sources question whether a German candidate can win wide support from other WHO member states. WHO Director-General Dr Tedros Adhanom Ghebreyesus has formally issued a call to WHO member states for nominations to the DG elections, scheduled for May 2027, in an invitation sent on 24 April to all WHO member states. WHO confirmed this in an email to Health Policy Watch. The invitations had been sent via private letters to countries’ Geneva missions. The period in which member states may nominate candidates will now run for six months, until 24 September. Contenders who have until now remained in the shadows are expected to begin coming forward publicly with their candidacies at the World Health Assembly in May. From the German perspective, Berlin wants its financial weight reflected in executive influence at the multilateral level as the largest global health donor following the US withdrawal from the WHO in January 2025. The withdrawal, combined with the US non-payment of dues owed, thrust WHO into a budget crisis, prompting layoffs of about 25% of the workforce in the past year. German Foreign Ministry neither confirms nor denies The German Foreign Ministry, formally responsible for the nomination, declined to confirm or comment on Braun’s potential candidacy when responding to a query by Health Policy Watch. Germany’s other potential candidates include the contested former Health Minister Karl Lauterbach and the lesser-known Paul Zubeil. In contrast, Braun’s dual profile as an accomplished politician, skilled financial manager, and trained physician and researcher who successfully built cross-party bridges offers a distinct advantage. But he is little known outside of Germany. Bridge-builder with executive and medical expertise Former Chair of the influential German Budget Committee, Helge Braun (right), and former French Chair of the Finance Committee, Claude Raynal (left), in the Bundestag. The current WHO leadership landscape demands a candidate capable of managing deep institutional fractures and uniting a divided global community. Despite him being largely unknown in the international community, Germany could be expected to emphasise Braun’s extensive fiscal and crisis management experience in any candidacy it mounts. As ‘Head of the Chancellery’, effectively Chief of Staff, in Angela Merkel’s last term as Chancellor, from 2018 to 2021, Braun operated at the nexus of scientific advice and political implementation during the COVID-19 pandemic, notably comparing the Chancellery to an intensive care unit where acute problems must be solved. Between 2021 and 2025, Braun then chaired the powerful Budget Committee of the German Bundestag (Parliament), overseeing the distribution and management of hundreds of billions of Euros with strict discipline This profound understanding of macroeconomic management, coupled with his pragmatic defence of Germany’s controversial debt ceiling alongside crisis-driven special funds, makes him an attractive prospect for donor nations currently demanding more financial accountability and restructuring at WHO in Geneva. Serving as a central mediator across government ministries, Braun built a reputation as a highly pragmatic problem solver whose past domestic political affiliations will not necessarily dictate his future approach to global health governance. This pragmatism complements his longstanding political advocacy for research into infectious diseases like Ebola and malaria. And unlike many career politicians, Braun’s foundational expertise lies in medicine, having worked for years as an intensive care physician and anaesthesiologist. He returned to these roots in April 2025 by assuming the presidency of the University of Lübeck, an institution renowned for its focus on life sciences and artificial intelligence. Why the candidacy might spark concerns WHO member states are currently negotiating a pathogen access and benefit-sharing (PABS) system in Geneva. While Braun championed early interventions and massive digitisation projects in his role as Merkel’s Head of the Chancellery during the COVID pandemic, severe bureaucratic delays hampered the rollout of vaccination campaigns and testing strategies. This tarnished his crisis management legacy just as he exited the federal government. His domestic political capital suffered further damage during the December 2021 Christian Democratic Union leadership election, where he lost heavily to conservative rival Friedrich Merz, now Chancellor. Party members largely rejected Braun as an establishment candidate, perceiving him as too closely aligned with the moderate legacy of former Chancellor Angela Merkel. Additionally, it is questionable whether Braun would wield the necessary diplomatic connections and familiarity with foreign health systems to be effective on Day One of a term as WHO head. The Director-General must immediately command trust and authority on the international stage, particularly when dealing with health ministries and stakeholders in the Global South. Most notably, the German government opposed the release of COVID-19 vaccine patents during his tenure, drawing sharp criticism from international health equity advocates. Defending this refusal in May 2021, Braun wrote in a guest article for the German newspaper Die Zeit that “patent protection as a driver of innovation is not the problem in this crisis, but an essential foundation for its solution.” In the Global South, this track record could thus reinforce the perception that Germany defends pharmaceutical interests over equitable technology transfer – especially in the face of current PABS Annex negotiations. Recent reports from Tagesspiegel Background indicating that the former minister was approached by Germany’s Association of Research-Based Pharmaceutical Companies to become their next president, when the post becomes vacant at the end of 2026, might further fuel these concerns. Finally, Germany has been cutting back its Official Development Assistance (ODA) in general, including contributions to the World Health Organization, where it has historically been the largest member state donor after the United States. On Wednesday, the Merz government announced its 2027 budget plans with further ODA cuts following last year’s drastic 17% reductions. The likelihood of Germany fulfilling its original 2024 financial pledge to WHO for the current biennium (2026-27) also remains in doubt. “They can put forward a candidate, but I don’t think it’s going to get a lot of traction from other member states,” said one informed WHO source. “At a time when Germany is reducing global health funding to member states, I don’t think they can go ahead and claim the top seat.” Step back and support allied candidates? Braun served as Head of Chancellery under then German Chancellor Angela Merkel, seen here with WHO Director General Dr Tedros in Berlin in 2021. Furthermore, domestic opinion remains highly divided on mounting a campaign amidst the geopolitical strains on Chancellor Friedrich Merz’s coalition and Tedros has reportedly urged Germany to back allied candidates instead. At the same time, the desire to seize more leadership in the UN system remains strong after Germany’s failed previous attempt to secure the top role at the UN High Commissioner for Refugees in 2025. Currently, Germany is also pushing for another attempt at a UN Security Council seat. Should Germany put forward a candidate, Foreign Minister Johann Wadephul, who will make the final decision, also faces a stark choice between Braun and the better-known Karl Lauterbach, as well as Paul Zubeil with his strong international health and technical background. Advancing a WHO outsider like Braun against established public health veterans is a highly calculated risk for Berlin, which must first convince other European countries to rally behind him. In case Berlin formally nominates Braun, the success of his candidacy will depend entirely on how effectively the government can reframe his perceived lack of field experience and global networks as delivery on fresh, badly needed fiscal expertise and perspectives. Grappling with WHO’s funding crisis As the race for the next Director-General opens for formal nominations, the names of over a dozen high-profile potential candidates are still circulating – from Indonesia to the United Kingdom. Want to Become the Next WHO Director-General? Get in Line And the list is still growing. Among the newer names being floated is that of Dr Hanan Mohamed al-Kuwari, who served as Qatar’s Minister of Public Health until November 2024 and chaired the 153rd Session of the WHO Executive Board. Before joining the Hamad Medical Corporation in 1996, where she ultimately rose to managing director, al-Kuwari worked for Reuters and as a freelance health reporter. Holding a PhD in healthcare management from Brunel University and bringing early career experience from the WHO, she represents a highly networked voice from the Arab world, celebrated for her crisis resilience and for shaping the WHO’s recent global work programme. Dr Maria Neira, former WHO Director of Climate, Environment and Health Another candidate who has been mentioned is Spain’s Dr Maria Neira, who recently retired from WHO as the director of Climate, Environment and Health. An iconic spokesperson for the climate, environment and health movement, Neira is known as a telegenic personality and adroit politically. As a young medical doctor, she worked in emergency relief in Latin America and Africa, and later served as Spain’s Vice Minister of Health and Consumer Affairs as well as President of the Spanish Food Safety and Nutrition Agency. However, Spain also recently decided to nominate a candidate to head the UN Food and Agriculture Organization (FAO), when Qu Dongyu’s second term as Director General ends in July 2027, leaving doubts about whether it would want to mount yet another campaign, in parallel. Continuing decline in ODA and global health aid Drastic ODA cuts and reduced global health funding leave vulnerable populations in precarious conditions worldwide. Whoever is elected will have to continue grappling with the continuing long-term declines in donor-driven ODA, and particularly global health aid – directly to countries and to WHO. While WHO 2026-2027 $4.2 billion base budget is now 85% financed, according to Tedros’ comments on Wednesday, declines in ODA continue to cast uncertainty on how the remaining $630 million gap will be filled. It’s unlikely that the $260.6 million in assessed US contributions still due for years 2024-2025, before the withdrawal became official in January, will ever be repaid, conceded WHO’s Tedros at a Geneva press briefing on Wednesday. “We’re hoping to get the money, but no signals yet,” Tedros told journalists, adding: “No signals means maybe we may not be able to get the money. The likelihood could be not getting the money.” “We’re looking at nontraditional donors. We’re looking at international financial institutions and other ways to mobilize that 15%,” Tedros said, in terms of filling that gap. “It’s not that we won’t go to the traditional donors, but I think we’re expanding that donor base.” This article has been edited to reflect additional information regarding Dr Hanan Mohamed al-Kuwari’s early career as a freelance journalist. Image Credits: X/Dr Tedros, Deutscher Bundestag/Leon Kügeler, European Commission. Posts navigation Older posts