From Baku to Belém: COP29—a transformative milestone in climate change and global health, focusing on neglected tropical diseases

As COP29 wrapped up in Baku, Azerbaijan, under the theme In Solidarity for a Green World, it became evident that climate action transcends environmental conservation; it is an urgent call to safeguard human survival. This year's conference was a pivotal moment to align health and climate goals, driven by a recognition of their inextricable link. Building on the momentum from previous COPs, COP29 introduced bold frameworks and fostered global collaboration to address some of the most pressing challenges of our time.

Central to the conference’s success was the establishment of the Baku COP Presidencies Continuity Coalition for Climate and Health. This coalition, co-led by Azerbaijan, Brazil, Egypt, the United Arab Emirates, and the United Kingdom, in partnership with the World Health Organization (WHO), signalled an unwavering commitment to placing health at the centre of climate policies. It provides a structure for sustained leadership and cross-presidency collaboration, ensuring that health remains a central pillar of climate action beyond political cycles and immediate priorities. It also aims to provide a long-standing framework to drive impactful health outcomes from past climate commitments. By bridging efforts across COP presidencies, the coalition reinforces sustained action and ensures ongoing momentum on critical health priorities as COP30 in Belém approaches.

Neglected Tropical Diseases (NTDs), as defined by the WHO, are a diverse group of conditions caused by a variety of pathogens (including viruses, bacteria, parasites, fungi and toxins) and associated with devastating health, social and economic consequences. NTDs are mainly prevalent among impoverished communities in tropical areas, although some have a much larger geographical distribution. They include conditions ranging from dengue and schistosomiasis to leishmaniasis and lymphatic filariasis. These diseases thrive in conditions shaped by poverty—poor sanitation, inadequate healthcare infrastructure, and limited access to clean water. Climate change exacerbates these vulnerabilities, creating new challenges for communities already struggling with these diseases.

Climate change is intensifying the spread and impact of NTDs through multiple interconnected pathways.

• Expanded disease vectors: Rising temperatures and changing rainfall patterns are enabling vectors such as mosquitoes, snails, and flies to expand their geographic range. Diseases like dengue fever, leishmaniasis, and schistosomiasis are now appearing in regions previously unaffected, including higher altitudes and latitudes.
• Increased disease transmission: Extreme weather events like floods and droughts disrupt ecosystems and create breeding grounds for disease vectors. For example, stagnant water following floods often leads to outbreaks of mosquito-borne diseases. Also, the movement of infected individuals from endemic regions to new areas facilitates the spread of diseases. Dengue fever outbreaks in South Asia have been linked to flooding, forcing communities into stagnant water-prone areas. Cutaneous leishmaniasis is increasingly seen in the Middle East and North Africa, exacerbated by climate displacement and worsening sandfly habitats.
• Heightened vulnerability: The compounded effects of poverty, food insecurity, and displacement due to climate change intensify the impact of NTDs on affected populations. These communities are often least equipped to adapt to the changing climate, creating a vicious cycle of vulnerability. Climate migrants often face significant barriers to accessing healthcare. Malnutrition, common in displacement settings, weakens immune systems and increases susceptibility to diseases. Vulnerable groups such as children, pregnant women, and the elderly bear the brunt of these challenges, while the psychological toll of displacement adds an additional layer of complexity.
• Strains on host communities: The influx of 'climate-induced migrants' often overwhelms host communities, particularly in low-and middle-income countries. Healthcare systems are stretched thin, reducing access to services for both migrants and host populations. For instance, in Kenya, drought-induced migration has intensified the spread of schistosomiasis and visceral leishmaniasis. In Bangladesh, the Rohingya refugee crisis has heightened the risk of waterborne diseases like cholera.

COP29 served as an opportunity to highlight these connections and call for integrated strategies to address both the root causes and immediate health impacts of NTDs in the context of climate change. However, the absence of a dedicated focus on NTDs remains a critical gap that must be addressed moving forward.

Future COPs should aim to adopt a more holistic approach to climate resilience, explicitly integrating NTDs into the global climate agenda. This requires breaking down silos between climate and health sectors and adopting innovative strategies to address the interconnected challenges.

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1. Leveraging Climate Finance for Health Outcomes

One of the most promising avenues for addressing NTDs within the climate framework is through innovative financing mechanisms. While COP29 discussions highlighted tools like the Green Climate Fund (GCF) and carbon markets, these mechanisms must be adapted to deliver health co-benefits.

• Health resilience bonds: These bonds could fund dual-purpose projects that enhance climate adaptation while addressing health challenges. For example, investments in flood-resistant infrastructure could simultaneously reduce the habitats of vectors like snails and mosquitoes, preventing diseases such as schistosomiasis and dengue.
• Carbon offset programs with health co-benefits: Reforestation and mangrove restoration projects, often undertaken as carbon offset initiatives, can also reduce mosquito breeding grounds, lowering the risk of vector-borne diseases. Expanding such projects with explicit health outcomes could be transformative for communities in NTD hotspots.
• Debt-for-health swaps: Countries struggling with debt should be allowed to negotiate relief agreements tied to investments in NTD prevention and control programs. This approach not only alleviates financial burdens but also channels resources into high-impact health and climate adaptation projects.

2. Embedding NTD Strategies in national adaptation plans

National Adaptation Plans (NAPs) are vital tools for countries to build climate resilience. Yet, many NAPs lack specific strategies for addressing the health impacts of climate change, particularly NTDs. Incorporating NTD prevention and control into these plans is essential for a holistic response.

Ethiopia serves as a model in this regard. The country’s NAP includes explicit health targets linked to broader climate adaptation efforts. By integrating measures like improved water management and vector control into its climate strategy, Ethiopia is demonstrating how health and climate goals can be aligned.

3. Building political will and partnerships

Political commitment is the linchpin of any successful intervention. The global community must prioritise NTDs as part of its climate agenda, leveraging existing frameworks such as the WHO's NTD Roadmap and the SDGs. However, this requires more than rhetoric—it demands actionable commitments from governments, donors, and the private sector.

• Public-private partnerships: Partnerships with pharmaceutical companies, which have already donated billions of doses of NTD medications, should be expanded to include climate adaptation efforts. These collaborations could fund integrated interventions, such as deploying climate-smart technologies for vector control.
• Regional collaborations: Initiatives like the African Union’s Agenda 2063 offer opportunities for regional cooperation on health and climate goals. Sharing resources, expertise, and best practices can amplify the impact of national efforts.

4. Empowering Local Communities

Local communities are often the first responders in the fight against NTDs. Empowering them with resources, education, and decision-making authority is essential for sustainable solutions. For example, in Mozambique, community health workers have been instrumental in reducing schistosomiasis by educating residents about safe water practices and advocating for improved sanitation. Such grassroots initiatives demonstrate the power of community-led action in addressing complex challenges.

International institutions and multilateral organisations like the WHO, the United Nations Development Programme (UNDP), and others play a pivotal role in bridging the gap between climate change and global health. Their expertise, global reach, and convening power uniquely position them to mainstream health into climate frameworks and advocate for equitable, integrated solutions, just as WHO has done in COP29 by putting health as a standing agenda in COPs. However, their impact hinges on them being rallied around by the global community to drive systemic reforms and foster collaborative action.

• WHO as a health-climate advocate: The WHO has made strides in recognising climate change as a critical determinant of health, producing influential reports and guidelines, such as its global action plan on health and climate change. To deepen its impact, the WHO should look to transition from a technical advisory role to a strategic advocate within climate negotiations. This should include formalising health as a core pillar of National Adaptation Plans (NAPs) and providing tailored support to countries integrating health metrics into their Nationally Determined Contributions (NDCs).
• UNDP’s role in capacity building: The UNDP has been instrumental in supporting low- and middle-income countries (LMICs) to enhance climate resilience. By embedding health into its climate adaptation programs, the UNDP can amplify its efforts. For instance, its Climate Promise Initiative—focused on NDC implementation—should expand to include explicit health-related goals, addressing vulnerabilities such as vector-borne diseases and waterborne illnesses exacerbated by climate change.
• Leveraging multilateral synergies: Other multilateral bodies, such as the Green Climate Fund (GCF) and Global Environment Facility (GEF), must be encouraged to allocate dedicated funding streams for health-climate initiatives. Partnerships among these organisations will drive innovation and resource mobilisation, ensuring that health is no longer an ancillary consideration in climate projects but a central component.

COP29 marked a significant step forward in the integration of health into climate action, driven by visionary initiatives like the Baku COP Presidencies Continuity Coalition for Climate and Health. This coalition has set the stage for a transformative approach to addressing the interconnected challenges of climate change and global health, signalling a new era of collaboration and shared responsibility. The global community now stands at a crossroads: to continue building on this momentum or risk losing valuable ground in the fight for climate justice and health equity.

As we look forward to COP30 in Belém, Brazil, the opportunity to deepen and expand these commitments has never been more urgent or achievable. The stakes go far beyond policy discussions—they affect the lives and livelihoods of billions of people. Addressing the health impacts of climate change, particularly the burden of NTDs and other climate-sensitive conditions, is not just a scientific or policy challenge; it is a moral imperative that tests the resolve of global leaders and institutions.

The path forward must include bold, actionable steps that transcend rhetoric. COP30 can serve as a historic turning point by:

• Elevating health to a central pillar of climate action: Health must move from the periphery to the heart of climate negotiations. This means not only recognising health impacts as outcomes of climate change but actively embedding health resilience into climate strategies at every level.
• Implementing the guiding principles for climate-health financing: Mobilising resources is critical to turning commitments into reality. Innovative financing mechanisms like health resilience bonds, debt-for-health swaps, and public-private partnerships must be scaled up to support comprehensive and integrated interventions.
• Establishing clear accountability and metrics: COP30 in Belém, Brazil, should champion the development of standardised metrics for tracking health outcomes within climate action frameworks. These metrics can ensure transparency, foster accountability, and measure progress on health-climate synergies.
• Fostering local and regional leadership: Climate-vulnerable nations and communities often bear the brunt of health impacts. COP30 must empower these regions through targeted support, capacity building, and the amplification of grassroots innovations that align with global goals.
• Integrating NTDs into climate policy: NTDs exemplify the intersections of poverty, health, and climate vulnerability. By explicitly addressing these diseases within National Adaptation Plans and other policy instruments, COP30 should ensure that no community is left behind in the pursuit of resilience and equity.

Next year, the upcoming COP30 in Belém, Brazil, presents a unique opportunity to inspire unity and purpose. Brazil’s rich history of leadership in global health and environmental advocacy positions it as an ideal host to advance these discussions. COP30 should aim to foster a spirit of collaboration that brings together governments, international organisations, private sector partners, and civil society to create a unified vision for the future. In the heart of the Amazon, where the stakes of climate action intersect with the urgent need to address health inequities, COP30 has the potential to ignite a transformative agenda. This must include tackling neglected tropical diseases (NTDs), which often arise from the very environmental and social vulnerabilities exacerbated by climate change. By championing both sustainability and the fight against NTDs, COP30 can pave the way for a healthier, more equitable world.