Introduction by Croakey: In May, the Pan-European Commission on Climate and Health made a series of recommendations for action on climate and health, including that the World Health Organization should formally declare climate change as a Public Health Emergency of International Concern (PHEIC), its highest level of alert for a health emergency.
The case for such a PHEIC declaration has only strengthened in the following months, amid climate disasters across many countries, says global climate and health expert Robb Butler, a former senior executive in the WHO.
“If Nepal’s floods, Europe’s heatwaves, Africa’s drought emergencies, rising sea levels, wildfires (everywhere) and the spread of climate‑sensitive diseases aren’t enough to trigger a WHO Emergency Committee convening, what will be?” he writes below.
Robb Butler writes:
Why has no country asked the World Health Organization to declare climate change a Public Health Emergency of International Concern (PHEIC) – despite the fact that it now meets every criterion of the International Health Regulations?
If the International Health Regulations are meant to trigger action when a threat becomes extraordinary, transboundary, and requires coordinated international response, then climate change has crossed that threshold. Not in theory – in real time.
In the past weeks alone, climate‑driven tragedies have unfolded in front of us: flash floods in Nepal, deadly heatwaves across multiple regions, fires, displacement, and health systems pushed past their limits. These are not “future risks.” They are mass‑casualty, cross‑border health emergencies happening now.
Climate‑driven mortality, disease spread, malnutrition, mental health harm, and health system disruption are observed, global, and accelerating. Vector‑borne diseases are entering countries with no prior history. Heatwaves, fires, floods, and displacement are hitting multiple regions simultaneously.
The risk is no longer hypothetical; it is international and acute.
What would a PHEIC declaration change?
Ministries of Health could have a much stronger mandate to access climate finance mechanisms that are currently dominated by environment and infrastructure sectors.
I am returning from the Aral Sea Basin where Ministers of Health of both Kazakhstan and Uzbekistan are struggling to secure domestic climate-environment-health financing for vulnerable populations affected by this environmental disaster.
There are also a host of other needed actions triggered by a PHEIC.
Historically, PHEIC declarations have accelerated donor commitments, emergency preparedness spending, and multilateral coordination.
If climate change were framed as a PHEIC or a similar health emergency, health impacts would gain greater visibility in climate negotiations and development financing, and governments could justify reallocating emergency and resilience funds toward climate-related health threats.
Multilateral development banks, philanthropies, and climate funds might prioritise health adaptation projects. These are woefully under-financed, currently.
Declaring climate change a PHEIC would align WHO action with current scientific consensus, rather than outdated risk models. It would signal a shift from recognition to protection.
It would also preserve the credibility of the IHR as a living instrument for 21st‑century health threats.
So why hasn’t WHO been asked to act?
Addressing barriers
The latest United Nations Environment Programme (UNEP) report points to vested interests, institutional inertia, and perverse financial flows propping up polluting industries.
This suggests that the same political shifts eroding hard-fought climate wins are blunting the pressure that countries place on entities like WHO, to use the tools at their disposal to mitigate and adapt.
Despite the financing a PHEIC would unlock for climate health action, countries fear what a PHEIC would imply: scrutiny, accountability, new expectations for surveillance and preparedness, and uncomfortable debates about climate injustice, sovereignty and capacity.
I understand that, but tackling a crisis of this magnitude is never going to be easy.
Other barriers include a narrow perspective or misunderstanding about what IHR can and cannot be used for; this might be blurring Member States’ understanding on whether the mechanism can be used. Many of us who have worked with PHEIC and emergencies for decades would argue it can, and that it makes IHR more valuable and useful.
Other hesitancy that I’ve heard has included the fact that we have a terrible Ebola situation with a related PHEIC, and there are concerns that calling a climate change PHEIC would affect that response. I don’t agree. The financing streams are different, as are the response mechanisms.
Sadly, health emergencies don’t form an orderly queue so that we can tackle them one by one.
Avoiding a declaration doesn’t make the emergency less real – it only makes the response weaker. A PHEIC is not about declaring catastrophe. It is about declaring the last moment when coordinated global action can still reduce harm.
That moment is now. Waiting longer won’t make the case stronger – only more tragic.
If climate change already meets the IHR criteria, and WHO leadership already calls it a health emergency, then the real question is: what are we waiting for?
If Nepal’s floods, Europe’s heatwaves, Africa’s drought emergencies, rising sea levels, wildfires (everywhere) and the spread of climate‑sensitive diseases aren’t enough to trigger a WHO Emergency Committee convening, what will be?
• This is an extended version of a post originally published on LinkedIn, which generated many supportive comments.
Author details
Robb Butler is a Visiting Professor in Practice at LSE Health, at the London School of Economics and Political Science. He is a senior public health and social science leader with substantial international experience delivering impact through public health, climate change, and humanitarian action. He is Former Executive Director and Director Communicable Diseases, Immunization, Environment at the World Health Organization and WHO Special Representative for Climate Change and Health, following earlier service as Executive Director at the WHO Regional Office for Europe and Central Asia.
See Croakey’s archive of articles on the climate emergency
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