br WHO estimates an additional

WHO estimates an additional 250 000 mortalities between 2030 and 2050 will be attributable to climate-associated increases in malnutrition, malaria, diarrhoea, respiratory disease, water inaccessibility, and heat stress. Spillover effects on state and regional security are inevitable. The World Economic Forum has identified climate change as the single greatest threat to global XMU-MP-1 because of its considerable consequences on the health and stability of developing nations. Analysis of factors contributing to multiple global crises are illustrative of climate change\'s effects on state stability. The ongoing civil war in Syria and the outbreaks of emerging tropical diseases, such as the Ebola and Zika viruses, are two such examples. Although multifaceted in origin, the Syrian conflict was preceded by the nation\'s most severe drought on record, which led to widespread food and water insecurity and deteriorating health outcomes. Pathogens such as the Ebola and Zika viruses are likely to become more frequent as they exploit already overburdened health systems struggling to address both existing and emerging care needs. The complex interaction between climate change, health system burdens, and poor health outcomes, and their subsequent impact on politics, security, and society can be captured within the concept of a so-called climate-health-security nexus. Many of the world\'s poorest and most politically fragile nations lie at the centre of this nexus. Within this nexus, poverty, state fragility, poor pre-existing health outcomes, and high susceptibility to climate change converge to amplify the effects of future famines, droughts, and neglected tropical diseases. This amplification subsequently leads to worsened economies, social instability, and reliance on external support. The nations most at risk for climate-triggered health crises are primarily scattered throughout sub-Saharan Africa and south Asia and are already afflicted by the highest rates of disease burden globally (, ). Notably, most of these countries are low-income nations without the resources to adequately contend with climate-related challenges.
Less than a year from now, a new Director-General will be elected to lead WHO. The next Director-General should commit to developing a global agreement on the research and development (R&D) of medicines, vaccines, and diagnostics of public health importance. This is critical in order to address the dual challenges posed by unaffordable medicine prices and a lack of innovation in neglected diseases, antimicrobials, and other public health priorities. Discussions at WHO on how to address failures of the current monopoly-based R&D system have been ongoing for over a decade, but R&D policy change is yet to occur and the will to address the root causes of the access and innovation crisis is still lacking. The imbalances in the current R&D system were the subject of the 2012 report of WHO\'s Consultative Expert Working Group on Research and Development (CEWG). The CEWG recommended a global binding agreement that provides a needs-driven and evidence-based framework for R&D, guided by the core principles of affordability, effectiveness, efficiency, and equity, and grounded in the concepts of delinkage and knowledge-sharing approaches. On the basis of the report, the 69th World Health Assembly passed resolution WHA69.23 to request the development of a plan for implementation of a pooled fund for R&D. In a recent report, the UN Secretary-General\'s High-Level Panel on Access To Medicines restated the need for negotiating a binding convention and called on governments to take action.
In December, 2014, an outbreak of suspected meningitis was investigated in Ituri District, northeastern Democratic Republic of Congo (DRC). Ituri shares borders with Uganda and South Sudan, is well known for political instability, and houses a large displaced population with limited access to health care. Meningitis was suspected by health workers due to neck spasm, interpreted as neck stiffness. However, further investigations (see for details) suggested that bacterial meningitis was not the cause of this outbreak. In the outbreak response that followed, participants provided verbal informed consent prior to interviews, lumbar puncture, and urine collection and the Government of DRC approved the outbreak investigation plan. The epidemiological pattern of the outbreak (curve, age distribution, evolution) was atypical for meningitis, there were few clinical symptoms or signs of this disease (eg, fever or neck stiffness), and only four of 83 patients who underwent lumbar puncture had cerebrospinal fluid evidence of Review of videos of patients by paediatric neurologists suggested facial-truncal dystonia, possibly secondary to drug administration. Dystonic reactions were defined as the presence of at least one of the following symptoms: muscle spasm of the face, neck, or arm; oculogyric crises; and protrusion and retraction of the tongue. Between December, 2014, and August, 2015, 1029 admissions to Médecins Sans Frontières or Ministry of Health centres met the case definitions of dystonia or suspected meningitis; 930 patients had at least one episode of dystonia. 448 (48·2%) were male, 311 (33·4%) were younger than 5 years, 265 (28·5%) were aged 5–15 years, and 354 (38·1%) were older than 15 years. The median duration of admission was 3·7 days (range 1–10). 11 patients died, five of whom were younger than 5 years (see for further details).