Global Resilience
“Roads to climate resilience are paved with nature as one of the most effective responses.”
Mirey Atallah, UN Environment Programme (UNEP) Page 04
“The biggest challenge for climate adaptation is in rapidly urbanising countries in Africa and Asia.”
Niels Holm-Nielsen, World Bank ONLINE
Fairly priced capital creates resilient communities and enterprises
The cost of capital for businesses and communities living in vulnerability erodes capacity for resilience. The disconnect between financial markets and resilience undermines communities’ ability to withstand adversities, making them dependent on external aid and emergency funding.
Recognising the economic value of resilient communities in emerging markets in the Global South can stabilise markets and reduce emergency funding needs.
Resilient communities stabilise markets
Resilience refers to the ability of communities to withstand and recover from adversities, such as economic downturns and health crises, and continue to develop. It thrives by fostering social cohesion, inclusive governance and robust support systems.
Communities that are more resilient potentially create significant financial value in the long run by stabilising markets and supply chains and reducing the need for reactive, emergency funding to reverse the damages of sudden shocks.
Market neglects SME resilience
Yet, financial markets often assess vulnerable regions as high-risk, rather than critical components of economic resilience without recognising the risk mitigation value they bring. For example, bank interest rates on business loans in the Global South can soar as high as 78% or more per year.
The result is a system where small businesses — one of the most critical elements to build resilience in developing markets — are unable to survive; not because of a lack of infrastructure but because of a vicious circle that has become entrenched in ‘market systems.’ Markets overlook the role of small and medium-sized enterprises (SMEs) in fostering cohesion
and resilience, as well as the positive societal and environmental effects they create.
Mispriced loans cripples businesses
Instead, the market unfairly attributes SMEs as having higher loan risks, despite the reality that certain sectors, like farming, boast nearly 100% repayment rates. The risk premium assigned to SMEs is overly inflated, resulting in capital cost that is not real-risk-adjusted but perceived-risk-adjusted.
SMEs are not only unable to compete with businesses with access to cheaper capital but are disincentivised to create the systemic outcomes the financing is intended to achieve. This cripples their competitiveness; instead of building resilient infrastructure in-country, it leads to import dependency, loss of job opportunities and a skewed power structure.
Breaking the cycle with fairly priced capital
This cycle of social vulnerability, high cost of capital and systematic undermining of locally based resilience and adaptive capacity is exacerbating susceptibility to shocks, particularly amid the climate crisis. Breaking the cycle through affordable financing and capital can yield significant economic, social, and environmental benefits and resiliency, particularly for Global South communities. This fosters equity and levels the playing field in the medium to long term, benefiting not only the community but also the region and the globe at large.
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Todd Cort Senior Lecturer in Sustainability, Yale School of Management
Clint Bartlett Partnerships and Innovative Finance Specialist, United Nations Development Programme
Jesper Hörnberg Head of Innovation, Global Resilience Partnership
Climate change is a global problem, but local action is key to supporting those most at risk
Climate change is creating new threats and challenges for people and communities around the globe, and in sub-Saharan Africa, those dangers are all too apparent.
Surface temperatures in the region have generally increased faster than the global average rate. Recurrent droughts and erratic rainfall have worsened years-long food crises in countries such as Namibia, Eswatini and Kenya. People who depend directly on their land and animals for their livelihoods have had their stability upended, with disruption to agriculture making it harder to provide for themselves and their families.
Tackling climate-related issues
The region is home to some of the world’s most resilient people, but the climate emergency is making life for millions ever tougher. In a cruel irony, those bearing the brunt of its dangerous and damaging effects are among the lowest contributors to global CO2 emissions.
With a growing need for international support for the people most directly affected by the climate crisis, the British Red Cross has supported many local African Red Cross and Red Crescent Societies in a three-year programme designed to boost resilience in the face of climate change and associated challenges.
leaving people at heightened risk from climate stresses. ELISSA has delivered expert training on livestock farming and crop disease prevention, helping farmers protect their income and maintain a more dependable food supply.
The programme has also helped to establish savings groups whose members, mostly women, support one another through incomegenerating activities and can access guidance on financial literacy and business development.
In Namibia, the National Red Cross Society has delivered training for over 1,000 small-scale farmers, helping them to increase their crop production by 10%. They also provided direct, flexible funding for them to invest in their farms, empowering them to put their skills and knowledge to use.
Supporting food security and water access
In Kenya, where millions of people have been facing food insecurity in recent years, and 41% of the population has limited access to safe drinking water, ELISSA supported the extension of water pipelines and the construction of new water points, benefitting over 23,000 people living at increased risk from droughts.
In other countries across the region, the programme established mother-to-mother support groups, distributing cash grants to women to start businesses and provide for themselves and their families. It also helped mothers of young children establish kitchen gardens, working with families to grow nutritious food in their backyards.
Locally led climate response
These kinds of interventions — targeted and designed in response to the situations facing individuals and communities — can be life-changing for the people so profoundly affected by climate change. While the crisis poses immense challenges, locally led action is key to confronting them and protecting lives and livelihoods.
For millions of people in sub-Saharan Africa, climate change is a pressing danger — one that requires commitment, determination and funding to confront.
Funded in part thanks to players of People’s Postcode Lottery, the Enhancing Livelihoods in Sub-Saharan Africa (ELISSA) programme aims to alleviate poverty and hunger by empowering people to achieve food and economic security. Launched in 2022, it is active in countries across sub-Saharan Africa, with over £3.3 million in vital support allocated to date.
Protecting livelihoods across communities
The landlocked nation of Eswatini is one of Africa’s smallest countries. Its mostly rural population depends largely on subsistence farming,
Local Red Cross and Red Crescent volunteers are often members of the communities they serve, and therefore have the best expertise on their needs and the challenges they face. By supporting our volunteer-led partner National Red Cross and Red Crescent Societies, we ensure that the benefits of our programme will continue for years to come.
For millions of people in sub-Saharan Africa, climate change is a pressing danger — one that requires commitment, determination and funding to confront. But while the threat isn’t going away any time soon, neither are National Red Cross and Red Crescent Societies.
An advertorial by
Sarah Clayton-Fisher Head of Africa Regions, British Red Cross
Joram and Susan, Kenya Red Cross staff, with Kizaro a farmer who’s now using seeds that have a shorter growth period than most typical maize. Esther Mbabazi / British Red Cross
The road out of climate hell: how to restore the world’s ordinary ecosystems
Humanity needs to drastically reduce greenhouse gas emissions, but to what extent can societies adapt and build resilience to the changes that are already coming?
May was the 12th warmest month on record. In its midst, Pope Francis warned we are on a “road to death.” Previously, the UN Secretary-General warned we’re on the highway to climate hell, reflecting the catastrophe of climate change.
Global climate resilience action
Humanity must reduce greenhouse gas emissions. However, even if all emissions were to halt overnight, the impacts of climate change are already here: extreme heat, drought, floods, cyclones and wildfires.
Roads to climate resilience are paved with nature as one of the most effective responses. Stories from communities across the world show us how: Rajasthan, India endured a devastating drought in 1986. Regenerated forests helped raise groundwater levels by several metres. In The Gambia, one of the largest development projects in the country’s history is restoring a degraded area — about the size of Paris — to improve water supplies. A lagoon in Albania acts as a natural buffer against coastal flooding and erosion. In Mexico, nature is reintroduced into cities to reduce flood risk. These examples rely on what some would call
‘ordinary’ nature. For a resilient society, all nature and all species are precious — not only those that are threatened or charismatic.
Cost of climate adaptation
Having more nature to fend off natural disasters is also a good investment. The economic cost from weather and climate events in 2023 was estimated at USD 301 billion and, by 2050, the overall cost for the global economy is in the trillions. Avoiding some of the worst impacts of climate-induced weather events can alleviate some of those costs.
Allocating 50% of all climate finance to support adaptation, up from around 5% today, makes economic sense. That would mean closing the USD 194-366 billion annual funding gap for adaptation needs.
At the same time, ecosystembased adaptation can only achieve so much. Without reducing global emissions, we risk triggering a chain reaction of ecosystems collapsing, no matter how much money is poured in to stop it.
Governments are expected to indicate their commitments to reducing emissions by February 2025. If these are not ambitious, or not implemented, countries might become entirely submerged.
In Africa, an extra helping of prevention and preparedness
can boost food security
Facing the worst food crisis since 2016, Sub-Saharan Africa’s 110 million people in acute food insecurity need urgent, climate-smart solutions for lasting resilience.
Iain Shuker Regional Director for Sustainable Development in Eastern and Southern Africa, World Bank
With headlines regularly touting the hottest summer or the worst disease outbreak, it may be hard to focus the world’s attention on growing food insecurity. Yet, this year marks the worst food security crisis in Sub-Saharan Africa (SSA) since 2016. As of April 2024, an estimated 110 million people were in acute food insecurity in SSA. Globally, most countries experiencing food crises are concentrated in Africa.
Conflict and climate shocks exacerbating crises
The reasons are manifold, but conflict and climate shocks are key drivers. Sudan has faced the most significant deterioration due to the devastating impacts of conflict since April 2023. El Niño has wreaked havoc in the region with severe weather events, including drier and hotter conditions in some places and heavier rains in others.
These events are hardly anomalous. As a result of climate change, these events are occurring at a much greater frequency than in the past. Countries that face consecutive crises have less and less time to recover.
Malawi, for example, was struck by cyclone Anna in 2022 and cyclone Freddy in 2023; it is now grappling with a combination of dry conditions and flash floods. Consequently, food is less available, and prices have gone up, forcing households to reduce their food intake.
Adaptation and food security planning
Since crises appear more and more as ‘the new normal,’ governments and development partners are starting to integrate them into their planning. At the World Bank, we are rolling out a new Crisis Response Toolkit, which will help countries provide faster relief when disasters hit — and save more lives.
Beyond emergency responses, we’re doubling down on the medium and long-term resilience agenda by helping countries address the root causes of food insecurity. Food System Resilience Programs, financed by the World Bank on an unprecedented scale, are now helping 15 countries and six regional organisations invest in climate-smart agriculture and integrated landscape management. Additionally, they are working to improve digital advisory services for farmers and strengthen strategic value chains. Another focus is promoting resilience in policymaking.
From Senegal to Madagascar, ministries, experts and farmers are having to adapt to rapid change. They always have reaped what they sowed. Now, more than ever, spending today for tomorrow’s resilience — and having access to cash when crops fail — is the most prudent way to boost food security.
Mirey Atallah Head of the Adaptation and Resilience Branch, UN Environment Programme (UNEP)
New tech and skills needed to transition jobs in polluting regions
COP28 marked a historic moment in transitioning away from fossil fuels. As countries aim to reduce CO2 emissions, policymakers must proactively support industrial regions to adapt before it’s too late.
Lamia Kamal-Chaoui Director, OECD Centre for Entrepreneurship, SMEs, Regions and Cities
As highlighted in the OECD Job Creation and Local Economic Development 2023 report, polluting industries are highly concentrated in poorer regions. In Europe, the proportion of employment in polluting jobs can be three times higher in the most exposed regions than in those least exposed. In these places, GDP per capita and wages are up to 38% lower than national averages.
New tech investment to save jobs
Polluting jobs keep unemployment low in those regions and tend to pay much better than other available jobs. In Zeeland, Netherlands, workers in the chemical sector earn more than double the region’s average wage. In some cases, those jobs can be saved through investments in new technologies. These include deploying hydrogen and renewable energy sources as well as carbon capture, utilisation and storage (CCUS). Our recent report for the Hamburg Chamber of Commerce, Reaching Climate Neutrality for the Hamburg Economy by 2040, highlights many examples of how governments can work with regions and industries to adopt those technologies. In Lulea, Sweden, for example, the Swedish venture Hybrit has produced the first fossil-free steel.
Green jobs concentration and skills gap
Yet there are still many challenges in implementing these technologies, and globally, carbon dioxide removal (CDR) will offset less than 20% of emissions. Moreover, it is not safe to rely on new jobs emerging from the green transition to replace polluting jobs in vulnerable regions.
Scottish university begins land regeneration project to capture carbon and restore biodiversity
Land in Scotland is set to benefit from the planting of new forests and restoration of peatland in a bid to offset unavoidable carbon emissions and restore biodiversity.
The University of Edinburgh’s Forest and Peatland programme will sequester around 1 million tonnes of unavoidable carbon over the next 50 years — produced by essential travel, including emissions generated by international student flights.
Scan
Aligned with the ambition to reach net zero carbon by 2040, the University has already divested from fossil fuels, introduced a presumption against domestic flying, works to a sustainable food commitment, has made climate one of its three research priorities and has strong commitments to decarbonise its estate.
Investing in carbon reduction While the University continues to do all it can to reduce carbon
First, because these jobs are instead gravitating to successful cities and capital regions. In 19 out of 25 OECD countries, the capital region has the highest share of green jobs, with more than a third of jobs already involving green tasks in Paris, London, Stockholm, Helsinki and Vilnius. Even where governments do direct green investments towards lagging regions, engineers, lawyers and consultancy firms tend to work remotely on these projects from big cities, and construction workers are present in the areas for only a short time and quickly move on.
Second, there is a yawning skills gap that prevents workers from transitioning from polluting to green industries. Countries must create clear plans for these regions to prevent increasing inequalities and growing resistance to the green transition.
Learn and adapt to grow sustainably
Immediate action is required, following the principles outlined in our recent report, A Territorial Approach to Climate Action and Resilience. Countries must learn lessons from past approaches to industrial transitions, such as the US Trade Adjustment Assistance (TAA), which sought to support US workers displaced as a result of global trade.
The EU’s Just Transition Fund (JTF) is an important step in the right direction — an attempt to support Europe’s regions most exposed to the green transition. However, countries need to learn from each other, and the past, to ensure that no region is left behind.
emissions from its own operations, the multi-million-pound woodland creation and peatland restoration scheme will offset any emissions that can’t be reduced to zero.
Regenerating land
A total of 891 hectares of land at three different sites — Drumbrae near Bridge of Allan; Rullion Green Wood in the Pentland Hills Regional Park and Barvick Burn Wood in Perthshire — is set to be regenerated by the University. As well as managing its own sites, the programme is working with landowners across Scotland to create woodland and restore peatland via negotiated payments to help them transition their land and support climate mitigation over 50 years of sequestration.
Yvonne Edwards, Forest, Peat
and Rural Land Manager, says: “The global climate emergency and biodiversity loss go hand in hand. Creating woodlands and restoring peatlands is a naturebased solution that will help us achieve our own environmental goals and, at the same time, restoring Scotland’s landscape, making it more resilient for future generations.”
Benefits beyond carbon
In addition to removing and storing atmospheric carbon, the planted woodlands and restored peatlands will enhance biodiversity and benefit local communities.
Scott Davidson, Deputy Director of Social Responsibility and Sustainability, adds: “In 2023, the University was ranked number four in the World (QS sustainability rankings) in recognition of our work to date, but we still need a step change in ambition to address the emerging environmental polycrisis.”
To realise this step change, the University is exploring an ambitious refresh of its climate strategy with an emphasis on biodiversity and a science-aligned decarbonisation pathway, en route to Zero by 2040. The University hopes to launch this later in 2024.
Scott Davidson Deputy Director of Social Responsibility and Sustainability, University of Edinburgh
Yvonne Edwards Forest, Peat and Rural Land Manager, University of Edinburgh
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WRITTEN BY
Sheree Hanna
Why clusters act as ‘magnets of innovation and expertise’ for life science firms
Science and technology clusters facilitate connections and collaborations between like-minded companies and institutions. They are key to accelerating innovation in the UK.
Science is all about connectivity,” says Dr Sam Barrell (CBE), Deputy Chief Executive of Europe’s largest single-site biomedical research institute, the Francis Crick Institute. “It’s a highly interdisciplinary field, so, to make life-changing discoveries and paradigm shifts, you need access to a diversity of scientific thinking from across the world. Crucially, you must be able to join the dots between those different areas of knowledge.”
Science and technology clusters facilitate connection
Dr Barrell is a big believer in science and technology clusters: hives of dynamic academic and corporate activity in a single neighbourhood. For example, the Francis Crick Institute is based in the Knowledge Quarter, a thriving hub of over 100 science and other knowledge-producing partner organisations in London’s King’s Cross/Euston area, which is home to 106 organisations, including University College London Hospital, the Alan Turing Institute and numerous small businesses and startups.
focused on developing and managing sustainable real estate, particularly for the life science sector. Its portfolio includes several campuses in the UK, such as the Regent’s Place campus in the Knowledge Quarter, where it collaborates with the Francis Crick Institute to offer state-of-theart laboratories and office space for biotech and pharma companies. British Land is also delivering Canada Water, a 53-acre scheme, with potential to become a significant innovation cluster.
Having a concentration of talent, resources and complementary occupiers in one area acts as a magnet to businesses that want to accelerate innovation.
“The proximity of all these organisations allows exciting local connections to happen in a powerful, synergistic way,” explains Dr Barrell. “Because London is a global city, it attracts connections with international talent, too.”
Sustainable real estate development
Mike Wiseman is Head of Workspace Leasing and Science and Technology at British Land, a property company
Tools to predict and prevent malaria outbreaks in a changing climate
The climate crisis is complicating the fight against malaria. We must redouble our efforts to eradicate this disease.
RConcentration of talent allows innovation to flourish
“Having a concentration of talent, resources and complementary occupiers in one area acts as a magnet to businesses that want to accelerate innovation,” agrees Wiseman. “Plus, the right collaboration with a larger neighbour or institution can give small businesses access to technology and facilities that they might not have themselves. If they have ambitions to grow, it’s easier to scale up on a campus location of several million square feet, in an environment full of expertise and entrepreneurialism. In the years ahead, the most exciting science advances will come from clusters.”
ising temperatures, shifting rainfall patterns and extreme weather events are creating unpredictable malaria outbreaks, expanding its geographical reach and potentially costing millions. However, through strengthened partnerships, the effective scale-up of existing tools and increased investment for new ones, eradicating malaria is possible.
Warming trends, shifting malaria landscapes Pakistan’s 2022 monsoon, amplified by the climate crisis, triggered a fourfold surge in malaria cases, turning low-risk areas into hotspots nearly overnight. Rising
temperatures are extending malaria seasons and nudging the mosquitoes that carry the disease into new areas and higher altitudes.
Better predicting the spread of malaria Like weather forecasting, we now predict malaria outbreaks. These systems monitor climate, mosquito populations and parasite genetics, creating early warning models for upcoming case surges. This data enables malaria programmes to prepare for outbreaks, deploy resources efficiently and protect vulnerable communities.
Initiatives like the Malaria Atlas Project and the Institute for Health Modeling and Climate Solutions are helping countries understand
their unique vulnerabilities and tailor responses accordingly.
Imagine being able to deploy limited resources like bed nets or medicines to prevent malaria in pregnant women before an outbreak — that’s the power of prediction in action.
Invest in new tools to end malaria
Better predictions are only the first step. To truly win the fight against malaria within a generation, we need a full suite of innovative tools and strategies, forged through a united effort. Researchers, governments, health authorities and professionals must work together to ensure the right tools are used to accelerate the development of new interventions. Consider durable vaccines with high efficacy, monoclonal antibodies and other potentially groundbreaking solutions like the modification of mosquitoes that carry malaria, so they can no longer spread disease.
The climate crisis may be creating new challenges, but by embracing cutting-edge disease monitoring technologies, strengthening partnerships and investing in innovative solutions, we can turn the tide on malaria.
Paid for by British Land
Mike Wiseman Head of Workspace Leasing and Science & Technology, British Land
Dr Sam Barrell (CBE) Deputy Chief Executive, The Francis Crick Institute
WRITTEN BY Tony Greenway
Dr Jennifer Gardy Deputy Director, Surveillance, Data and Epidemiology, Bill & Melinda Gates Foundation
Clear climate-health connection impacting conditions for women and girls
Ainee Kohli and her daughter Aneeta in Tharparker, Pakistan, where Ainee became a climate champion through a programme led by Pathfinder International. Ainee educates other women about climate change adaptation and sexual and reproductive health.
The climate crisis is threatening food security, driving the spread of infectious diseases and stripping women of their rights and livelihoods. The climate-health connection requires action now.
Climate change significantly affects women’s and girls’ reproductive health, which may surprise many due to the infrequent acknowledgement of this connection. Urgent action is necessary to prevent it from reversing the progress already made.
Climate crisis exacerbates inequities
Climate change is increasing crises such as desertification and floods, impacting local health systems and depleting local resources.
“Often, women and girls are impacted most,” says Dr Tabinda Sarosh, Interim CEO at Pathfinder International. The nonprofit organisation collaborates with local partners in 21 countries to enhance health systems’ resilience, and sexual and reproductive health and rights.
Dr Sarosh says: “Climate change leads to denial of sexual and reproductive health services and rights, increases food and water
insecurity, impacts livelihoods and economic security and worsens existing inequities — in every country where we work.”
Disasters disrupt women’s health
During severe flooding in Pakistan, 625,000 pregnant women were displaced. Around 70,000 of them gave birth in camps in a single month, where delivery conditions are often unsafe. Pathfinder provided safe delivery kits, humanitarian food assistance and counselling on family planning. Bangladesh is regularly affected by cyclones, and the Government has shelters where communities take refuge. However, in the shelters, women and girls may not have access to the menstrual health products, clean water and privacy they need.
“This is particularly distressing in a culture where menstruation is a taboo subject. Lack of menstrual health products can lead to physical health issues but can also impact mental health, particularly for adolescent girls,” says Dr Sarosh.
Access to food and water
Climate change may exacerbate food insecurity, especially among women and children. Dr Sarosh says: “We have worked around Lake Victoria, in Kenya, Tanzania and Uganda, helping women in the fishing industry. We support women as leaders who encourage sustainable fishing practices and entrepreneurs to ensure they aren’t pressured into coercive practices.”
Water management is also essential. Pathfinder International, alongside the Government, is running a pilot project in Egypt to boost eco-friendly water waste management at health clinics, aiming to improve their resilience to extreme heat and water depletion. Simultaneously, Pathfinder works with communities near the clinics to improve awareness about health resources, household resource management and entrepreneurial skills.
What can be done?
Action must be local: “We need more health system assessments, but critically, solutions must be evidence-based and locally led,” says Dr Sarosh. The resilience and preparedness of health systems must be assessed in relation to local climate threats. As of 2021, only 27% of countries had conducted climate-resilience assessments of health facilities.
Community engagement is essential : To manage climate change adaptation, early warning systems, dissemination of critical information, as well as integrated climate, health and livelihood activities are crucial. Technology may help. For instance, in some communities, digital applications can quickly connect individuals to social safety nets and resources for climate resilience and education.
Empower women in climate policy: The leadership and development of women and young people is vital, to enhance their participation, voice and agency in climate actions and decisionmaking. Meanwhile, health and gender considerations must be at the forefront of climate policies.
Dr Sarosh says: “COP28 in 2023 was the first to deeply examine the impact of climate change on health. This means more leaders will be renewing country action plans on health, which is good news for women and girls.” Such awareness and action can enhance outcomes for women and girls while mitigating the climate crisis’s impact on their wellbeing.
Paid for by Pathfinder International
Tabinda Sarosh Interim CEO, Pathfinder International
WRITTEN BY
Linda Whitney
Photo credit: Photo by Ali Rizvi
Making healthcare more sustainable by scrapping single-use
Swapping single-use equipment for reusables in hospitals could save money, lower emissions and reduce infection risks. So, why are we still throwing so much kit away?
Globally, healthcare contributes 4.4% of total greenhouse gas emissions. Medicines, machines and the high-energy demands of hospital buildings contribute to healthcare’s carbon footprint. One simple initiative could drastically reduce this environmental and financial cost: swapping single-use products for reusables.
Wasted resources in healthcare
“About three-quarters of everything used in healthcare is thrown away,” says Professor Mahmood Bhutta, NHS surgeon and Professor of Sustainable Healthcare at Brighton and Sussex Medical School (BSMS). While some healthcare equipment cannot be safely reused, like needles, Prof Bhutta says a lot of the equipment could be made reusable.
“Currently, 75% of the drapes and gowns worn in the NHS are single-use. There is no reason for them to be thrown away; they can be cleaned and sterilised,” says Prof Bhutta. “In surgery, we use a harmonic scalpel to dissect certain tissues. Each one costs the NHS about £600 and, because they are single-use, we’re throwing away hundreds of thousands every year. Yet, we know for certain they can be made reusable.”
Reusable tools enhance patient safety
In some cases, ditching single-use items can make patients safer: even throw-away plastic gloves contain bacteria when they come out of the box, according to Prof Bhutta. “I, as a patient, would much rather
someone be touching me with cleaned and washed hands than the contaminated glove.”
The Sustainable Healthcare Group at BSMS, led by Prof Bhutta, swapped disposable instruments with reusable tools in several of the hospital’s surgical and outpatient departments. His team predicts it could save the hospital over £200,000 each year while, crucially, maintaining high safety standards.
Promoting reusable medical equipment
Despite studies that show the swaps bear no increased risk of infection, some remain sceptical. Meaningful change requires incentives for companies to design reusable products, enabling healthcare staff to safely reuse equipment.
“We need everybody in this complex dissipated system to be saying the same thing: this is what you should do, and this is what’s safe,” says Prof Bhutta. “Government, hospital executives and healthcare workers should agree to preferentially buy and use reusable equipment in the NHS — anywhere and everywhere it is safe to do so.”
Professor Mahmood Bhutta
(DPhil FRCS) Chair, ENT Surgery and Professor of Sustainable Healthcare, Brighton and Sussex
Medical School
WRITTEN BY
Amy Arthur
HIV drug resistance to dolutegravir on the rise in low and middle-income countries
Learn about HIV viral suppression and emerging HIV drug resistance to dolutegravir.
Antiretroviral therapy (ART) has revolutionised HIV care and treatment, allowing nearly 30 million people to live healthy lives. HIV drug resistance (HIVDR) reduces the effectiveness of antiretroviral drugs for HIV treatment and prevention, leading to an increase in HIV incidence, morbidity and mortality.
In 2018, dolutegravir (DTG)-based ART became the World Health Organization’s (WHO) preferred HIV treatment for children, adolescents, and adults. By July 2023, 91% of 127 low and middle-income countries adopted DTG-based ART, which has the benefit of rapidly achieving undetectable HIV viral load levels and has a reduced risk of developing drug resistance compared to other ART drug combinations. However, with the incorrect use of DTGbased ART, there is a risk of the emergence of HIV drug resistance (HIVDR) — leaving DTG ineffective at controlling HIV.
Dolutegravir: population-level viral suppression and drug resistance outcomes
In its HIV Drug Resistance Report 2024, WHO documents high levels of viral load suppression (>90%) in populations receiving dolutegravircontaining ART. These results bring us one step closer to the goal of ending AIDS by 2030. Yet, recent observational data reveal that HIVDR to DTG is emerging at levels that are surprising to many experts, exceeding those observed in clinical trials.
Among people not achieving viral suppression, levels of dolutegravir resistance range from 3.9% to 8.6%, with levels as high as 19.6% observed among highly treatment-experienced people who transitioned to a DTG-containing ART while having high HIV viral loads. In a study in South Africa,1 DTG resistance soared from 2.7% in 2021 to 11.9% in 2022 in people with
laboratory-confirmed treatment failure and DTG use.
WHO’s response to this new evidence WHO recommends that countries routinely implement standardised surveillance of HIVDR to follow the prevalence and patterns of resistance among people not achieving suppressed viral load. Despite massive efforts to transition to DTG-based HIV treatment since 2018, only 10 countries have finalised acquired HIVDR surveys among adults receiving DTG-based ART, and only six countries have implemented surveys of acquired HIVDR among children and adolescents receiving DTG-based ART.
To date, countries reporting HIVDR data were early adopters of DTG-based treatment and have not repeated surveys; available results may underestimate the true prevalence of DTG resistance and preclude analysis of trends over time. WHO calls on countries to routinely implement and report data from standardised surveys characterising the prevalence, risks and patterns of DTG drug resistance. Surveys inform the quality of treatment programmes and influence care and treatment guidelines.
How to support HIVDR surveillance Greater funding and political will are required to sustain and expand global HIVDR surveillance efforts. Without steadfast commitments from international organisations, governments, programmes and funders to address challenges associated with HIVDR, we risk unnecessarily losing lives, the effectiveness of our best HIV treatment in decades, being without a replacement in sight and putting us off-track to reach UN sustainable development goals by 2030.
Meg C. Doherty World Health Organization, Geneva, Switzerland