As COP31 puts a spotlight on the health hazards of air pollution, Dr Lesley Russell reports on its impacts in India, where she found climate change to be a regular topic of conversation.
The Health Wrap also examines health issues at stake in recent elections in the United States and Aotearoa New Zealand, as well as covering the latest global research developments in vaccines, a cancer breakthrough, and best practices in primary healthcare for First Nations men.
The quotable?
Burning fossil fuels is a major source of both air pollutants and greenhouse gases, so cutting it improves air quality and slows warming at the same time. On the road to #COP31, aligning clean air policies with national climate plans is a direct investment in public health.”
Lesley Russell writes:
The Health Wrap is back after my wonderful trip to India, spent mostly travelling in Rajasthan. It was an amazing experience, with so much to see and think about.
I loved exploring the cities and towns and small villages; hiking to forts, temples and palaces; an early morning balloon ride; a trek into the Thar Desert; searching for tigers in the Ranthambore National Park (we saw two, plus a rare sighting of a leopard); learning about the history and culture; and – of course – the people and the food.
The consequences of climate change were a constant theme when talking with locals.
It was unseasonably warm during my visit (temperatures most days were in the mid 30s Celsius and summer temperatures in this part of India are now routinely in the high 40s).
The recent monsoon season failed to deliver the needed water for crops and animals: Rajasthan recorded a rainfall deficit of over 20 percent, the worst in 16 years.
Groundwater levels are dropping rapidly due to heavy pumping for irrigation and urban expansion, which is visible everywhere.
The photo I have chosen to highlight my trip (see below) is not of the marvellous colonial architecture of Mumbai, the lakeside palaces of Udaipur, the Taj Mahal or the Red Fort of Agra, but of a rural farm area. It was taken during an early morning balloon flight.
As the sun rises through the smoky haze (due in large part to burning off at the end of the harvest), it highlights well- tended fields surrounded by trees and rock and brush fences. Many have been ploughed for winter plantings of vegetables and crops like mustard.
You can just make out the small family compounds, usually surrounded by domesticated animals such as cattle and goats.
Our balloon took a new direction and – because such sights are rarely seen in this area – caused great excitement. People stood on their roofs to wave and the whole village came to watch us land.
Early morning ballooning near Jaipur
Air pollution and health
Last week was the 6th annual international Health Environments and Lives (HEAL) conference, which has been well reported by my Croakey colleagues.
The impacts of wildfires and smoke on health, and how to protect communities (such as those I saw in India) as the climate changes were among the topics covered.
Croakey’s coverage (with more to come): https://www.croakey.org/category/croakey-conference-news-service/heal2026/
To highlight the extent of this problem, a recently published study shows that, at the height of the Los Angeles fires in 2025, millions of residents were exposed in a 24-hour period to toxic lead levels from smoke that were 80 times higher than the typical background level.
And to harken back to my India experiences: Most days, in most areas (even the most rural), there was a heavy smog, especially in the mornings. My chest, throat and eyes often burned from exposure to the polluted air.
A 2024 study in The Lancet Planetary Health estimated that 3.8 million deaths in India between 2009 and 2019 were linked to air pollution.
While Delhi’s toxic smog is a recognised problem, it was also very noticeable in Mumbai, where the city skyline was barely visible during an early evening walk along the ocean promenade.
A recent article in The New York Times highlights what Delhi is doing to address the pollution caused by its notorious traffic. Nearly nine million motorcycles, scooters, auto-rickshaws, private cars, taxis, trucks and buses crowd the city’s roads. Most run on fossil fuels.
The authorities have instituted a Winter Action Plan but experts argue this is a seasonal “Band-Aid ritual” that fails to address root causes, ground-level enforcement gaps, and core scientific realities.
Sunset through the smog along the ocean promenade, Mumbai
COP31, the United Nations climate change conference, is taking place in Antalya, Türkiye, from 9 to 20 November. These issues are on the table.
America has voted
The United States saw a blue Democratic tsunami across the nation at the federal and state levels in the recent midterm elections.
The results amounted to an unambiguous mandate from the public for a check on a president who has pushed the limits of his power and ignored their growing concerns over affordability, the war with Iran, and the erosion of democracy.
The unexpectedly large gains by the Democrats can be seen as a rebuke of Trump’s and Republicans’ health reform agenda and the role of the Make America Healthy Again movement.
The Democrats who will now take over as Members of Congress (in both the House of Representatives and the Senate), as state governors and as representatives in state legislatures look like today’s America: a diverse array of people in their 30s and early 40s; lots of women (including the first Gen Z woman elected to Congress) and people of colour (including at least two Native Americans); people from the LGBTQI community; a former Paralympian who uses a wheelchair; and the first Muslim Senator.
Voters are hoping that they will quickly begin to deliver on their campaign promises. Key among these is addressing the costs of healthcare.
Healthcare ranked second in voter concerns ahead of the midterms in a Gallup poll, with 50 percent saying the issue is extremely important and 27 percent saying it is very important.
We can expect legislative action: to undo the cuts Trump has made to research funding, Obamacare, Medicaid, and other social welfare programs; to improve access to care in rural and under-served area; to redress women’s reproductive health rights; and to tackle medical debt.
A significant number of the new Members of Congress favour some form of Medicare for All, loosely defined as a plan for all Americans to get health insurance from a single federal program instead of private insurance companies. And recent polling shows that two-thirds of voters support this.
The chances that Trump will suddenly want to work with Congressional Republicans are slim (remember the battles he had with Nancy Pelosi in 2018-2019?) and most likely he will veto much of what is sent to him to sign into law.
But it will be important for Democrats to show that they want to address these issues and that Trump and his Cabinet are the barriers that prevent this happening.
Voters will be impatient for real and positive changes and if these are not delivered, they will take their revenge in the 2028 presidential elections.
This was the most expensive US election ever. It is estimated that an incredible US$11.9 billion was spent on getting people out to vote. Elon Musk spent US$446 million – almost all of it on candidates who lost.
Imagine if that funding had gone to health and healthcare – or replacing all the funds DOGE stripped from USAID!
Democrats’ Election Rout Is Poised To Dramatically Reorder Federal Health Policy
See related Croakey coverage.
New Zealand has also voted
Across the ditch, Aotearoa New Zealand has also held general elections.
It was predicted to be a cliffhanger, with the polls showing neither major party gaining enough seats to form government.
Counting the votes and then the formation of a new government notoriously takes a long time in New Zealand where the minor parties play a key role. This year, with both major parties (National Party and Labour) out of favour, that process is expected to take even longer.
As I write this, preliminary results showed the right-wing bloc led by Prime Minister Christopher Luxon and the Nationals slightly ahead on seat count, despite the fact that Luxon is deeply unpopular (Labour’s Chris Hipkins went into the election with an 11 point lead in the preferred prime ministerial stakes).
But hundreds of thousands of special votes, including those from overseas, are still to be counted and could change the outcome. These votes have traditionally skewed toward left-leaning parties. The official result will not be released until 27 November.
The issues for voters echoed those in the United States and Australia – rising living costs, access to health services, and economic management.
The healthcare problems are familiar: difficulty accessing general practice; workforce shortages; pressure on emergency departments and elective services; an ageing population; rising costs of medicines and technology; persistent inequities; and hospital infrastructure requiring substantial investment.
Luxon’s National-led Coalition Government in New Zealand has faced intense criticism and widespread protests over policy rollbacks that critics argue deepen socio-economic and racial inequalities for Māori.
The dis-establishment of Te Aka Whai Ora (the Māori Health Authority) without an alternative plan raises questions about the health system’s capacity to address avoidable Māori health inequities.
The revised primary care funding formula, which came into force in July this year removed ethnicity as one of the key indicators, despite evidence it is an important independent predictor of health need.
See Croakey’s NZ election coverage
Major cancer breakthrough
An Australian-led phase 3 trial of a world-first, tailor-made mRNA cancer vaccine has dramatically cut the risk of melanoma recurrence and death compared with patients who were only given the immunotherapy drug pembrolizumab (sold as Keytruda).
The combination of immunotherapy and the personalised cancer vaccine is described as an “incredible breakthrough” that will usher in a new era in cancer research and treatment.
The press release announcing the results is here. Note that final data from the trial is not yet publicly available.
Trial participants had all previously undergone surgery to remove their melanoma tumours. All 1,137 were given pembrolizumab. Two-thirds were also given a personalised mRNA vaccine designed to enable their immune system to recognise and destroy their own distinct cancer cells, while the remaining patients were given a placebo injection.
The trial, funded by Merck and Moderna, found that, at two years, 82 percent of trial patients who received both treatments were alive and melanoma-free, compared with 70 percent of those who received pembrolizumab alone.
The study’s principal investigator is Professor Georgina Long, from the University of Sydney and medical director of Melanoma Institute Australia.
She said in a statement that the “results represent a landmark moment for adjuvant melanoma treatment”.
Long was the joint recipient of the 2024 Australian of the Year Award, with her colleague, the late Professor Richard Scolyer. These results can be seen as the crowning glory of their work together.
You can read more here. And also see this post by Melanoma Institute Australia.
Updates on vaccines
Pancreatic cancer vaccine breakthrough
The story above highlights the breakthroughs that are possible with mRNA vaccines. Among these is a Phase 2 trial, led by Mayo Clinic researchers, of a vaccine against pancreatic cancer, which is so very difficult to treat.
The findings were recently published in Nature Medicine. This research is now proceeding to Phase 3 clinical trials.
You can read more here.
The on again / off again, unethical hepatitis B vaccine trial
In December last year, just two days after the US Centers for Disease Control and Prevention (CDC) announced that it would no longer recommend hepatitis B vaccinations for all American children, the allocation of a US$1.6 million grant from HHS for a study of hepatitis B vaccine in newborns in Guinea-Bissau was announced.
It was swiftly denounced by global public health experts as unethical for proposing to not provide a potentially lifesaving birth dose of the vaccine to half of the newborn study participants (in a nation where almost one-fifth of adults and more than one-tenth of children are infected with hepatitis B). As well, the research team involved a husband and wife from the University of Southern Denmark – lionised by Health Secretary Kennedy, who were under scrutiny for “questionable research practices”.
In January 2026, amid global outrage, the trial was paused.
In February, the World Health Organization stated it had “significant concerns regarding the study’s scientific justification, ethical safeguards, and overall alignment with established principles for research involving human participants”.
In early October, it was reported that the CDC Director’s office in September set aside US$1.6 million from money directed by Congress for CDC global health security programs to help fund the trial which would then proceed.
(Readers will remember that the appointment of Dr Erica Schwartz as CDC Director came amid questions about how independent she would be from Kennedy.)
However, in late October it was reported that the vaccine trial would not proceed, in large part because it was not given the necessary governmental approval by Guinea-Bissau. The Government now has control over the researchers’ vaccines which will be used to roll out immunisations out to all newborns in 2028.
E coli vaccine trial terminated
A phase 3 trial of an investigational vaccine targeting the Escherichia coli pathogens that commonly cause urinary tract infections, bacteraemia and sepsis didn’t show a protective effect in older adults and has been terminated early.
These results were reported in Lancet Infectious Diseases. The researchers found that systemic immunity was clearly induced but this might not have been of sufficient magnitude or quality to provide clinical protection infection.
The results are disappointing as there are currently no licensed vaccines targeting invasive E. coli disease that causes common and dangerous medical emergencies in older adults.
Lyme disease vaccine trial also fails
A Phase 3 trial of an investigational Lyme disease vaccine covering six serotypes across four Borrelia species that cause this disease had a vaccine efficacy rate of over 70 percent but it missed a preset success threshold of 80 percent.
The trial did not technically fail due to safety issues or a lack of real-world efficacy, but rather because of a statistical problem caused by low infection rates among the participants.
While this result looks promising, it required four vaccine shots annually to achieve this sub-optimal level of protection.
However, the developers, Pfizer and Valneva, are pushing forward with regulatory submissions to seek formal approval from the FDA and European regulators.
No vaccines are currently available for Lyme disease. The FDA approved a recombinant vaccine in 1998, but the manufacturer pulled it from the market in 2002 amid side effect worries and diminishing sales.
More Ebola vaccines for trial
The World Health Organization (WHO) has announced that two new Ebola vaccine candidates will be added to the ongoing Tumaini clinical trial in the Democratic Republic of the Congo (DRC).
The recommendation marks the first time vaccines specifically designed to protect against Bundibugyo virus, the virus responsible for the current outbreak, will be evaluated during an outbreak of the disease.
The two vaccine candidates, which have been specifically designed to protect against Bundibugyo virus strain causing the current outbreak, are ChAdOx1, developed by the University of Oxford with the Serum Institute of India, and Moderna’s mRNA-1469.
WHO’s independent Technical Advisory Group on Candidate Vaccines Prioritization recommended both for further clinical evaluation this week, based on available preclinical and early clinical evidence. The companies were informed on Monday. The vaccine candidates will enter the trial following national approvals.Will the midterm results save vaccines?
The political changes wrought by the midterm elections will bring new allies for public health in the Congress and state legislatures, and a recent article in MedPage Today asks if this will address the current existential threats facing US vaccine programs (and the international vaccines programs that the United States used to support).
The short answer: don’t count on it!
We can expect continued aggressive anti-vaccine actions from Kennedy, there are a number of important lawsuits underway, and public trust in vaccines must be restored from the current all-time low.
And two sad stories to highlight the consequences of the anti-vaccine sentiment in the United States:
Last week an infant died of measles in Wisconsin, the state’s first death from the disease in 36 years. This was the third measles-associated death reported last week, after one in each of New York and Pennsylvania (where now six deaths have been reported this year).
Reports of infant brain bleeds have increased as the percentage of newborns receiving vitamin K shots has fallen.
Peptides in the news
Without finalising any new approvals or regulatory changes, the Department of Health and Human Services (HHS) has submitted a peptide “interim access policy” to the White House for review.
This policy would allow compounding pharmacies to produce and sell six previously restricted peptides that are lauded by Health Secretary Robert F Kennedy Jr and alternative health enthusiasts for their purported health, beauty and anti-ageing benefits.
In July, the FDA’s Pharmacy Compounding Advisory Committee (PCAC) – stacked by Kennedy with members who support his approach to peptides – voted in favour of adding these six peptides to the list of substances compounding pharmacies can make.
The interim policy is designed to allow these peptides on the market while the FDA develops permanent rules. This despite these substances being banned by FDA previously because of serious potential safety risks and despite the continued lack of evidence supporting their purported benefits.
Kennedy is a self-described “big fan of peptides” and has described how he has used them. He promised action to expand access to them and says compounding pharmacies must be allowed to sell peptides because Americans are currently using unsafe “grey market” versions of these drugs made in China and other countries.
MAHA proponents argue that restricting these substances is an “aggressive suppression” of personal choice, alternative health, and health optimisation.
People Say These Peptides Hurt Them. Their Stories Are Muffled in MAHA’s Push for Medical Freedom.
The MAHA-driven push for self-directed biohacking and online grey markets has spilled over internationally, prompting strict regulatory pushback and warnings in Australia from the TGA and Ahpra regarding unapproved injectables and telehealth prescription crackdowns.
See MAHA peptide wave erodes Australian healthcare.
Such warnings seem to have done little to stop the promotions. Just type “Australia peptides” into your search engine and you will be shocked at what comes up.
The 13 April edition of the New Yorker has an interesting, if scary, long read on peptides: Why Are People Injecting Themselves with Peptides? Health and wellness influencers are hawking unapproved treatments on the gray market. The future of the F.D.A. – and the health of consumers – is at stake.
(Read more on peptides in the 2 November edition of The Zap.)
Mooted changes to Medicare
Talk about addressing specialists’ fees continues – but action lags.
As usual this difficult problem has been shunted off to committees; two are currently looking at this issue.
The Department of Health, Disability and Ageing has a consultation on specialist affordability and access which is specifically considering fee caps.
A parliamentary inquiry into access and affordability of medical specialists has a broader remit.
The DoHDA committee has released a consultation paper on excessive specialist fees. The paper acknowledges that accessing specialist care different to purchasing other goods and services. This, combined with the fact that specialist care is taxpayer-subsidised, makes a case for greater regulation.
The proposals outlined include:
Establishing caps on the fees that specialists can charge
Sending warning letters to specialists who consistently charge in excess of an established threshold (three times the Medicare schedule fee has been mentioned)
Financial incentives for specialists with lower out-of-pocket costs.
All of which seems a bit wimpy to me. Back in April Labor said it would “test the boundaries” of the Constitution in efforts to curb high out-of-pocket specialist costs. Hmmm!
The 2026 Health of the Nation report from the RACGP was released late last month. It makes the case that the increasing complexity of care needed by patients is restricting the time GPs can spend on preventive care.
The report said longer consultations were being driven principally by increasingly demanding clinical care, rather than administrative or technological barriers.
You can read more here.
In this light, it’s timely that the MBS Continuous Review is looking at MBS time tiered items.
In a very timely move – one tinged with frustration that there has been so little action – the Grattan Institute has just released a new analysis of specialist fees that finds these have continued to rise, well ahead of inflation, since an earlier report released last year.
The Grattan Institute calls on the Government to make a concrete plan with tougher reforms to stop rising fees and long wait times: “The Albanese Government is proud of its strong commitment to Medicare. It’s time to demonstrate that commitment by making sure all Australians can afford the specialist healthcare they need, when they need it.”
The authors of this new report have summarised their findings in this article in The Conversation.
In case you missed it
A quick summary of recent health news.
Walking can boost creativity
We all know that walking has many health benefits, including improving longevity and making your brain younger. Now research also shows that walking boosts creativity by helping people come up with new and novel ideas.
You can read more here. And I was intrigued to learn that Ann Patchett, one of my favourite writers, works on her wonderful and creative books at a treadmill desk.
Why are we talking about fluoridation?
The NHMRC will review the nation’s guidelines for fluoride in drinking water. The current statement is here.
This is apparently in response to issues raised by South Australian Liberal senator Alex Antic (who has previously spoken out about the dangers of fluoridation). He has pushed for NHMRC advice to be reviewed in light of research indicating that fluoride crossed the placenta and was linked to “adverse neurodevelopmental outcomes”, including reduced intelligence in children.
In fairness there is some new evidence to be considered:
A January 2025 assessment from the US National Toxicology Program found an association between fluoride and lower IQ but noted this does not prove a cause and effect and that “many substances are healthy and beneficial when taken in small doses but may cause harm at high doses”.
A viewpoint paper published in the Annals of Global Health provides a high-level summary of key critiques of this link and the corresponding responses “to help the public, media, and the scientific community better understand the strength and implications of the scientific evidence on fluoride exposures and neurodevelopment and cognition”.
A 2025 longitudinal study that found no difference in the IQ of Australian children who were exposed to fluoride during early childhood and those who weren’t.
Older Americans who vote live longer than those who don’t
(I couldn’t resist including this although I’m not sure how robust the finding is!)
An article in the US edition of The Conversation finds that people who vote live longer than people who don’t.
Researchers used data from the Wisconsin Longitudinal Study, which has followed a sample of Wisconsin high school graduates since 1957. They compared the longterm health of older adults who voted in the 2008 presidential election (who can forget that wonderful time when Obama was elected president) to those who did not vote in that election.
They found that voters were 45 percent less likely to die within five years after the 2008 election, 37 percent less likely to die ten years after the election, and 29 percent less likely to die 15 years later.
You can read the original paper here.
To quote The Conversation article: while exact explanations aren’t known, “participating in civic life – even something as simple as casting a ballot – may be good for your health, like going for a run or eating vegetables”.
The study does show that the mortality benefit was not moderated by individuals’ financial resources or political affiliation.
Healthcare for First Nations men
A recent article in The Conversation from researchers in Indigenous health at James Cook University looks at what is needed to deliver healthcare services that fit the needs of Aboriginal and Torres Strait Islander men.
It is based on a paper by these researchers, published in The Medical Journal of Australia.
The key point of this work is that – like all Australian men – Aboriginal and Torres Strait Islander men are not simply “hard to reach”, nor are they uninterested in their health. They will readily engage with healthcare service when they are accessible, relevant and delivered in an environment where they feel culturally safe and respected.
The barriers are often practical and structural: difficulty getting appointments; lack of male health professionals; concerns about confidentiality; previous negative experiences; shame or embarrassment; culturally inappropriate environments; and services that are not designed with men in mind.
Not surprisingly, the services provided by Aboriginal Community Controlled Health Organisations provide the clearest examples of best practice delivery.
And the authors refer to the exceptional work of individual programs like Enough Talk, Time for Action, a program co-designed by Flinders University researchers and Aboriginal and Torres Strait Islander men to improve primary healthcare engagement and social and emotional wellbeing.
An evaluation of this program is here. The conclusion states in part: “Participant narratives illustrate the profound social and emotional wellbeing and empowerment outcomes that can be achieved from engaging with culturally responsive health programs, particularly when men are actively involved in the design and delivery of healthcare initiatives aimed to address their needs.”
The article in The Conversation summarises the practical changes that governments and every health clinic can undertake to make it easier and more encouraging for First Nations men to proactively engage with primary care services and thus improve their health status and wellbeing.
Two recommendations stand out:
Extend funding timeframes for Aboriginal and Torres Strait Islander men’s health programs from two to three years to at least five years. Short-term funding leads to staff turnover, disrupts relationships and forces organisations to spend enormous energy repeatedly applying for funds.
Properly fund (more) male health workforce positions.
Best of Croakey
In recent weeks Croakey has had an important series of articles looking at the harms caused by anti-immigration politics and how these might be countered.
This sort of “dog whistle” language is becoming increasingly common in Australia (we can blame One Nation’s imitation of Trump, and the foolish efforts of the Coalition parties to gain back lost voters).
Health and medical leaders urged to stand against political racism
Anti-migrant politics ignores a basic truth about Victoria’s health system
New communications guide – how to counter anti-migrant scapegoating
Tackling the harmful framing of migrants.
The good news story
I couldn’t resist returning to things I learned in India for this segment.
I travelled there with Intrepid – a wonderful Australian company I had previously used for last year’s women’s-only hike in the Atlas Mountains of Morocco (about which you can read more here), and will certainly use again.
Intrepid has a social conscience and looks to work with and build communities in the countries where they operate, with a particular focus on women’s needs.
In India, in conjunction with ACCESS Development services, the Intrepid Foundation has launched the Pink City Rickshaw Company in Jaipur (known as the Pink City).
This is a social enterprise/non-profit initiative that trains and employs low-income and under-privileged women to drive custom-built electric rickshaws. It also is in several other Indian cities.
The women drivers earn roughly 500 to 600 rupees per ride which is more than triple India’s minimum daily wage. They are helped to gain financial independence, mechanical training and maintenance skills, financial and business literacy, and ownership paths.
I did see some of these cheery, pink rickshaws but did not have a chance to ride them. You can read more and also see photos on the Intrepid website here.
Croakey thanks and acknowledges Dr Lesley Russell for providing this column as a probono service to our readers. Follow her on Twitter at @LRussellWolpe.
Previous editions of The Health Wrap can be read here.
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